Civitas Health Unit

James Gubb, 3 May 2007

Since 2000, the NHS has witnessed a huge, and unprecendented, increase in funding. Public spending on the NHS has risen from £46.0bn in 2000/1 to an estimated £84.4bn in 2006/7, representing an increase of 83.5% in cash terms and over 50% in real terms.
This has been accompanied by reforms that on the one hand point towards a more patient-centred and primary-care led ‘internal-market’ for healthcare. Primary Care Trusts and GP practices now purchase secondary care from NHS Trusts (or private providers) on behalf of patients, who can exercise some choice over where they are treated. NHS Trusts will be paid for the work they carry out; money should in theory follow the patient. But on the other hand, the government has created a whole raft of central bodies to provide ‘the impetus for reform’ and, more often than not, set targets that NHS bodies are expected to meet on anything from patient records to waiting times.

The money and the reforms have produced some notable achievements – for example, on waiting times and falling cancer and CHD mortality rates. Yet the NHS is beset by serious problems. Despite the huge increase in public spending, many NHS Trusts have huge deficits, staff morale is at record lows despite real salary increases, and public expectations are far from being met.
What is more, the NHS is producing health outcomes that are poor by international standards. Fatalities from strokes, for example, are near or above 100% higher in the UK than Australia, Canada, Japan, Sweden, Switzerland and the US. Between 1999 and 2003, only four out of 26 developed countries performed worse than the UK in terms of deaths before the age of 70 that were potentially preventable by good medical care; the UK’s absolute ranking on this measure actually fell from 17th to 19th. OECD studies have also discovered that the larger the number of doctors per head, the lower the avoidable mortality rate. The number of practising physicians per 1,000 population increased in the UK from 1.9 in 1999 to 2.3 in 2005. However, despite this increase, the UK is still well below the OECD average of 3 per 1,000 and ranks 24th out of 27 nations. The NHS in its current form does not look sustainable.
The CIVITAS Health Unit has therefore been set up to bring fresh thinking to the debate on NHS reform and to consider whether there are better ways to provide quality healthcare for all at affordable cost. It aims, in particular, to bring together individuals and groups from within the medical profession, and across the political spectrum, to build an enduring consensus on the future of healthcare provision in the UK. To this end, we will look at the extent to which the current reforms are working, look closely at healthcare systems used in other countries, and use this as a guide to develop possible alternatives to the current NHS. For enquiries, or to help us in this work, please contact: james.gubb@civitas.org.uk.