How to revive public healthcare | The Economist

How to revive public healthcare | The Economist

This year Britain’s National Health Service celebrates its 70th birthday. Formed in 1948, it was the first state health service in the world. Today, the modern NHS
is almost unrecognizable from the one that was
created 70 years ago. It’s the world’s fifth biggest employer with a budget of 110
billion pounds a year. But it’s in urgent need of treatment. Like many healthcare
systems, the NHS is faced with a funding shortfall
and critical staff shortages meaning its future looks perilous. Lord Ara Darzi is one of
the world’s top surgeons and a former British Health Minister. He’s been on the healthcare
frontline for three decades. And he’s come up with a
plan for reviving the NHS. These are my talking points. The government needs to
transform the NHS from a sickness service to a
health and wellbeing service. Most of the chronic disease
is related to human behavior. The NHS spends almost nine billion pounds a year dealing with
diseases related to smoking and the growing obesity epidemic. To cut costs, the
government needs to tackle this public health crisis at its root. We do this in three ways. One, regulation, banning smoking was a wonderful example of that. Second, taxation. Introducing sugar tax,
or a levy on alcohol. Thirdly, behavioral intervention. How do we help people
make the right choices? We need to embrace innovation
whether that is digital which has transformed
every aspect of our life, we need to do the same in health. The NHS is still running on paper and fax. We need to move from that archaic times into the new times of digital. The NHS is the world’s largest purchaser of fax machines and in some hospitals, medical equipment is no
longer fit for purpose. A recent report found that
machines from the 1980s were still in use in NHS hospitals. We need to decommission the old stuff and save money to pay
for the new innovations. Robotics, new drugs, new interventions. We need to look at frugal innovations, technologies that are exceptionally cheap but at the same time
delivering as good an outcome from a patient’s perspective. In the 21st century, data is the energy or the fuel of transformation. Anything you could measure you can improve and data is one of the ways of doing that. One million people use
the NHS every 36 hours. But there’s no centralized
system where doctors can access their medical data. Most patients seeing me expect me to have all the data from their general practice. We need to drive this integration between primary care, hospital, and
back into the community. You can actually predict
disease before you see the manifestation of disease
by segmenting the population and identifying those at great risk. To do this, the NHS will have to tackle fears over personal data being shared. Sharing data is critical
from a patient’s perspective. And we need to win the
confidence of the public when it comes to the privacy and
security aspect of data sharing. The NHS is facing a funding gap. By 2020, it’s estimated to
be 20 billion pounds short. A lot of people out there
think investing in healthcare is in a bottomless pit. I could confidently tell
you, not just my work, look at the work of the Lancet Commission, the World Innovation
Summit for Healthcare, the best return on investment any country could make is in health. Healthy nation means a productive nation. Healthy nation means economic growth. For every pound you spend in health, you get two pounds back. Quality should be the organizing principle of any health system. It’s a wonderful future if we embrace it.

59 thoughts on “How to revive public healthcare | The Economist

  1. Bring more muslim doctors and nurses in NHS you won't regret they are more intelligent than the white doctors

  2. Every thing he has said is correct. I confirm as a scholar of economics. And yes people all around out the world need Health system not Medical system. Prevention is better than cure.

  3. Step 1: Cut down immigration. Prevent health tourism. Charge those coming over for free health care as we'd get charged in their poverty stricken backwards countries for healthcare. Also fine the drunks.

  4. True story: sometime in '92, both my sister and I were in the same hospital, undergoing spinal surgery for scoliosis. For me, it was my first, but it was the second for my younger sister; the first operation didn't quite work out, has her curvature literally bent the non-ferrious (possibly titanium rod), out of shape … by pure chance the same surgeon operated on us both, so as I was wheeled out of theater, my sister was rolled in … Mr. Edgar (now retired), was a top surgeon, and Lead Spinal Orthopaedic Consultant

    Pity about the hospital, though … The Middlesex (now long since closed), was out of the early days of the NHS; state of the art back then, creaking at the seams by the time we were both admitted …

    I mention all of this because of what happened next. My sister was on a syringe pump that could easily be mistaken for a reel-to-reel deck, it was that old, big, and damn heavy looking. To dial in the dosage, one literally had to spin the dials on the front, rather like yon olde tape counter … problem was, you could hardly see the decimal point. Given the extensive surgery my sister went through, she was on a high dosage of pethadine. Her dosage need upping, so a trainee nurse adjusted this thing … to ten times what it should have been …

    According to what my mum told me, when the mistake was realised, all hell broke lose … Mr. Edgar blew another gasket (he had blown one previously over a 'mistake' a night nurse made about my chest drain … when he did his usual rounds the next morning, I noticed him shifting his feet in an odd way, before he looked under the bed … to discover that my 1.5L chest drain had overfilled onto the floor, to form a large puddle … I will never forget that face when he looked up … he remained calm and polite with me … but my God, I bet he ripped through the night staff like a tornado, out of sight … I knew things were bad when he immediately ordered four units, typed, and cross matched, followed by another four, 8 hours later … and yes, I still did come down with an peritoneal infection … almost hit 40oC … in that heatwave … fun times …)

    Anyway, this pump was consigned to storage, whilst he and his 'firm' tried to restablize my sister … he did … luckly …

    But the upshot was my mum organized a whip-round amongst the other parents, and indeed the staff, to raise funds for a brand new syringe driver …

    I hoped things had got better, but it sounds like very little has …

  5. Yes please! ban smoking and a sugar tax, i wonder how many people are going to complain, death or ciggies, you choose?
    I'ts way better for this to happen rather than to privatize – Whats better for their lifestyle and all developing children, to have access to things that harm and kill you or to eradicate it?
    Or do we give people free choice / free will, that invariably harms others and them selves & costs so much that the system will fail?

    So i guess option 1. do you want no NHS and privatised health care with ciggies and sugar that obnoxiously kills your self and others
    or option 2. a clean England with a efficient NHS?
    What is better for everyone?

  6. What about stopping socialized medicine? Which is nothing more than rationing healthcare service and products to the population instead of allowing private hospitals to be grow and spread.

  7. The claim that foreigners/immigrants call them what you will, contribute to the health service and impose a nominal cost on it could be an interesting use of statistics. There have always been many Irish staff in the NHS and they are counted as foreigners/immigrants while a Nigerian with British citizenship using the NHS but for all practical purposes resident in Nigeria is not counted. An example was the tragic murder of Damilola Taylor whose family were in the UK so his sister could have the extensive treatment she needed on the NHS to which their British passports entitle them. As Prime Minister Gladstone said 150 years ago there are lies damn lies and statistics.

    You have to collect fragments of information & piece them together yourself. In about 2001 London Hospitals told the BBC the cost of new immigrants with TB & HIV was wrecking their finances. Months later the Chief Executive from a London Hospital group (Newham?) that probably catered for more ethnic minorities than any other in the UK was interviewed on Radio 4's flagship Today. There was a bland discussion about the work of his group that concluded with a question about people from abroad using the NHS to which he replied, “Patients who are not entitled to treatment only cost us £30k a year and on our £20+ million budget that is absolutely nothing". He did not say that to control the spread of TB and HIV the government had correctly ordered immigrants with these conditions be given priority and given them more money. Consequently as "immigrants" were counted as "entitled". He was misleading but not ACTUALLY lying. Neat?

    Here we have a 2013 report on tuberculosis from the Governments Public Health England

    It includes the following interesting statement; “Eight out of 10 Londoners with tuberculosis in 2012 were UK-born OR had been living in the UK for at least 2 years prior to their diagnosis.” So as far as Government statistics are concerned if you have been living here for 2 years before you are diagnosed you are a “LONDONER” and not included in the statistics as an “immigrant” and the implication is you caught it here.

    This is possible because the Center for Disease Control and Prevention informs us,

    “Some people develop TB disease soon (within weeks) after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason. Many people with TB infection never develop TB disease.”

    But we eliminated TB 50 years ago so where has it come from? The “Eight out of 10 Londoners” line is just the latest fudge.

    My reference to the BBC report at the beginning can be sneered at but think about it. If the NHS is not putting budgets for communicable diseases like HIV, tuberculosis and hepatitis cases in any community before British pensioners hip replacements it is not doing its job.

    On a more basic level the Guardian reported the 50% increase in population in Ely principally from Eastern Europe, meant the local Doctors had to employ three interpreters at £40 an hour. A radiographer was unable to treat a Hungarian lady as the £100 an hour interpreter missed the appointment. Of course the NHS has employed interpreters for years mainly for languages from the Indian subcontinent so you can say it is nothing new. In theory no, but as they tell us there are now over 300 languages spoken in London a quantum leap in costs is an undeniable fact. It would appear the more obscure the language the greater the cost so how could this be built into budgets? A doctor who occasionally locums as a GP in London is paid £800 a day so for eight hours work a Hungarian interpreter costs the NHS as much as a doctor.

    To test the system a Hungarian journalist came to Britain and obtained a European health card then went back to Hungary for treatment and presented the card thereby charging her treatment in Hungry to the NHS. Details from the Guardian,

    Instead of screaming xenophobe and racist at people pointing out these problems just explain how you can bring in an estimated 3 million people from countries where they have poorer health care, concentrate them in particular areas, and not have a strain on health and other services.

    Can I make it clear I consider the Hungarian lady coming to the UK for free treatment is what anybody, including myself, would do in the circumstances but in other EU countries nonresidents are only treated for accidents and emergencies. Those who arrive with serious long-term conditions are required to return to their home countries. Even in basic things like maternity care the Foreign Office advises British women who are pregnant that they will receive routine treatment in Germany, but they cannot go there to give birth. When I had a minor accident in Portugal and a friend had to see a Dr in Spain we both had to get our credit cards out and pay £40 in £100 respectively.However Britain has an open door policy and you only have to walk into a hospital or surgery to receive whatever treatment is necessary.

    We are also reminded of the burden retired British people place on for example the Spanish health service. Well it's not a representative sample but I can name two British families who maintain addresses in the UK so they can return to get NHS care whenever it is necessary. I am currently having a course of treatment costing £700 a time and have too schedule my work and holidays around it. The staff assured me that it would not be a problem because they had British expats who flew back from Spain for the same treatment.

    In conclusion on the basis of over 30 years as a local government manager I can say categorically that the strain on housing and education is entirely due to immigration. I can back this up with extensive details but until 1997 we were demolishing modern social housing because it was surplus to requirements. As for education we had been running down, converting to other use, closing and some cases demolishing primary and high schools from the 1980s onwards because there were simply not enough children coming through to fill them. One district had 3 High schools until 1997 now it has one and suddenly finds it is short of places.

    Having seen the impact on these services at first hand to suggest there has not been a similar effect on the NHS is illogical.

  8. Step 1: tax the rich properly.
    Step 2: no tax havens
    Step 3: no sending money out of the country to families abroad. Or a tax on that money would work…

    Stop letting money leave the UK

  9. It should be called How to survive the NHS, they are killing people with chemo, I had a blood test and was told I had Rhumatoid Arthritis, now they've changed their minds and don't know what it is, all the doctor's I've seen so far are foreign, do they actually know what they are doing, I gave them my mum's name and date of birth so they could look at her records for clues , isn't that patient confidentiality broken.
    You can guarantee my next diagnosis will be cancer, and it will be them who injected it , and I won't be taking the steroid tablets they gave me, all that does is make you put weight on. Look at the breaking news at the countess of Chester hospital, a nurse has been killing babies, and they won't give her description or ethnic details , but if she was white British they would

  10. The government know it's the immigrants costing the NHS billions, they should be charged for their treatment

  11. NHS systems are fantastically outdated. We need a total unified digitalised overhaul, preferably without paying IBM billions of pounds for diddly squat (look it up, it fully happened) it will save millions a year and save lives lost to poor bureaucracy

  12. The idea that a sugartax intervenes in behaviour is laughable, you will hit certain groups harder than others, in my country there are both high taxes on sugar products and tobacco, this is not the main driver for a reduction in smoking, I'm sorry but this is a typical liberal response to issues, yes selective restriction is a good idea though but a total ban is not the answer, neither for alcohol neither for drugs, how about we start putting reference intake knowledge in daily curriculi for a start and data is an easy answer for everything I'm sorry but this surgeon had quite some generic answers which are presumably not even in his field of expertise

  13. I agree with a lot of what he said but there are some things I don't agree with. Such as:
    1: '' Sugar/Alcohol/cigarette tax '' — I don't think this will be effective as people will find other ways to purchase it, for example the prohibition era. Also this would be hard to action. Those industries bring in billions for the UK and we will face a lot of backlash
    I think a more effective way is investing in educating people about health and offering tax breaks/investments for companies that promote healthy eating/living

    2. ' For every pound you invest in healthcare, you get two pounds back '' — This is bullshit. Its not even measurable. Other industries contribute to a better society as well such as education and technology.

    A quick fix to all of this would be to privatise the NHS but that comes with its own set of problems lol

  14. its a common neo-liberal conservative tactic: defund programs to the point of failure, so they look inefficient and unsalvageable, then privatise for a profit. Thatcher was elitist scum and so are those trying to follow in her footsteps.

  15. Let's be realistic, Labour under Corbyn is the first political party willing to properly invest in the NHS since the 2008 financial crisis

  16. So… because you can't manage a health care service other people have to stop smoking, stop drinking and reduce sugar. WTF.

  17. Cut foreign aid and mass migration.

    Defend our borders.

    Deport isis and useless prisoners who are not worth investing in.

    Deport our 1m+ illegals

  18. NHS have  destroyed  my MRI  notes  and  told me  that  they  will never ever  help  me. Since  2009  daily have lived  with a  GP  telling  me that I can die  any day  and no one   at all cares about  me  who  should be  doing .2010 I nearly  died  with  complications  and a  journalist  I  contacted laughed her head  of  at me who I  spoke  to on the telephone. I trust   no one after  what  have  endured .

  19. LOL how is the NHS still running on paper and fax? There are tons of healthcare record keeping systems out there.

  20. I would add that contracting out services such as imaging, cleaning, procurement and PFI contracts drain money from patient care. We need to stop this & give up the tory ideology of privatising everything. Jeremy Hunt should hand back procurement to the NHS as it is the single source of fraud within the NHS. Every order for stationery, medical equipment that is ordered and goes missing is money Jeremy Hunt'sfirm, SBS pockets money. The clue is in the name, the NATIONAL Health Service, National.

  21. In the training and revision conferences, all Drs should be trained how to Introduce themselves in a mannerly way.
    1)Use eye contact and make the patient feel they are in safe hands.
    3)Give GPs. longer to asses the issues.
    4)Preventative medicine only works when people are educated about their issues. Not by being treated like they are too ignorant to know the facts.
    5) I agree totally that all information should be shared. Try needing a GP, neurologist and oncologist….they never communicate and if you try to share what you know so far you are shunned by whomever you are lucky enough to see after three months wait.
    6) 70 is not past your sell-by date and the chances are 70 plus eat better, walk more often and have never and been obese so deserve some reward. Not to mention years of having paid

  22. 2:25 Innvoation – bullshit. NHS is not failing because of technology, he is talking like an IT Project manager trying to get budget… They fail before they see the patient. NHS should be renamed National Sickness Service. Crowded A&E, too few nurses and doctors and Too many sick people – they are just the symptoms. Too much obesity, as a result of unhealthy eating and drinking is where it starts. Get children to eat healthy at school and home and half of your country would be healthy. Cut down on alcohol and sugar and another quarter will be better. Then we will need fewer doctors. More doctors will not solve any problem, technology of today will be archaic in 10 years. All the IT he is talking about has a shelf life of 10 years. Invest a billion on healthy food for kids at school and the country will be healthier.

  23. Electronic health records in USA … made clinics ask if dr can type 95 words per minute, go through pages of electronic data n tell patients to log into their account to see what dr said.. they killed bedside manners n its all in three minutes.. the amount of transcribing error in electronic prescriptions is so scary that as a pharmacist i hyperventilate… good luck calling n reaching the dr.. i work in an underserved area that has been declared no longer underserved… NHS defunding is following American modules where you throw a bomb on the already broken medical system n hope that will fix the system.. except if you are super rich then “ access” to medical care is not an issue

  24. This Dr IS the problem… social health care will inevitably lead to cost over runs and mismanagement. This has already happened.. And then he has the nerve to suggest limiting freedom is the solution. Exactly the process described in the book “The Road to serfdom” In small incremental steps you trade your freedom.

  25. Banning smoking and increasing taxes on cigarettes manufacturing company is a solution, is it ,???????? Really ………..then why 💯% countries who are consistently practicing this solution never solve this problem

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