>The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500?
It's a moving target, because need continues to grow as the population ages. We're in largely uncharted territory, so it's difficult to make long-term cost forecasts. You could always find ways of spending money to improve a healthcare system, so it just doesn't make sense to pick a number ex nihilo. We do have other, better means of determining what a reasonable level of healthcare spending might be on a year-to-year basis.
The National Institute for Clinical Excellence have determined a cost-effectiveness threshold of £30,000 per additional Quality-Adjusted Life Year. This threshold is a little bit arbitrary, but it's a reasonable rule-of-thumb as to what treatments provide a net benefit to society. Based on this figure, we can start to calculate a reasonable overall NHS budget from the bottom-up - the NHS needs enough money to provide all the healthcare interventions that NICE has determined to be cost-effective.
In addition to cost-effectiveness, we also have benchmarks in terms of quality of care. It might not be clinically significant if someone has to wait three weeks for a GP appointment about their psoriasis or six months for knee surgery, but it matters to the patient. We know that wait times have been going up and patient satisfaction is going down, which is a reasonable indication that the system is underfunded. It wouldn't be reasonable to aim for instant care and 100% patient satisfaction, but we should at the least hope for stability rather than regression.
The question of affordability is perfectly fair, but the UK doesn't spend an exceptional amount on healthcare by the standards of equally-developed nations. As a proportion of GDP, our spending is roughly average for OECD nations. In absolute terms, we spend about 25% less per patient than Germany or Ireland. We can clearly afford to spend a fair bit more before we start feeling the pinch.
I think that it's perfectly reasonable to spend a few tenths of a percent of our GDP to try and take the pressure off the system and get the quality metrics back to where they were in 2015. If costs start spiralling out of control, then we need to have some difficult conversations about what kind of care we're going to ration, but I think that conversation is premature if we haven't first tried a modest increase in spending.
Incidentally, one of the provisions in the ACA over in the US specifically prohibits the use of QALY as a cost-effectiveness threshold. It's just one of many reasons it's so absurd for Americans to point to the NHS as a demonstration of how much more cost-effective healthcare would be if it were nationalised; something like the NHS with its cost-saving measures just wouldn't be politically viable there.
It's a moving target, because need continues to grow as the population ages. We're in largely uncharted territory, so it's difficult to make long-term cost forecasts. You could always find ways of spending money to improve a healthcare system, so it just doesn't make sense to pick a number ex nihilo. We do have other, better means of determining what a reasonable level of healthcare spending might be on a year-to-year basis.
The National Institute for Clinical Excellence have determined a cost-effectiveness threshold of £30,000 per additional Quality-Adjusted Life Year. This threshold is a little bit arbitrary, but it's a reasonable rule-of-thumb as to what treatments provide a net benefit to society. Based on this figure, we can start to calculate a reasonable overall NHS budget from the bottom-up - the NHS needs enough money to provide all the healthcare interventions that NICE has determined to be cost-effective.
In addition to cost-effectiveness, we also have benchmarks in terms of quality of care. It might not be clinically significant if someone has to wait three weeks for a GP appointment about their psoriasis or six months for knee surgery, but it matters to the patient. We know that wait times have been going up and patient satisfaction is going down, which is a reasonable indication that the system is underfunded. It wouldn't be reasonable to aim for instant care and 100% patient satisfaction, but we should at the least hope for stability rather than regression.
The question of affordability is perfectly fair, but the UK doesn't spend an exceptional amount on healthcare by the standards of equally-developed nations. As a proportion of GDP, our spending is roughly average for OECD nations. In absolute terms, we spend about 25% less per patient than Germany or Ireland. We can clearly afford to spend a fair bit more before we start feeling the pinch.
I think that it's perfectly reasonable to spend a few tenths of a percent of our GDP to try and take the pressure off the system and get the quality metrics back to where they were in 2015. If costs start spiralling out of control, then we need to have some difficult conversations about what kind of care we're going to ration, but I think that conversation is premature if we haven't first tried a modest increase in spending.