Anything the NHS can do, it can afford
Money is not the real problem in the NHS, more money is not the answer
Inflation is a complex subject. At root its a simple imbalance between supply and demand. Too much demand chasing too few goods.
We know today that we are out of balance, both in the UK and around the world. Policy changes to restore that balance are likely to be painful in the short term. Interest rate rises, cuts in public spending, restrictions on pay increases.
The money response to NHS inflation
What does all this mean for the NHS? The bad news is that three unhelpful effects are obvious:
1. The cost of medicines, medical devices, consumables and everything else the NHS uses will rise.
2. Government will seek to constrain NHS budgets despite all the hype about more money.
3. The path to constraining cost will include low pay rises for the NHS workforce.
We already underpay and overwork people in the NHS. In combination, these effects will make that situation worse. Media and commentators of all kinds will engage in a bitter debate. On the one hand, the argument that there is no alternative, the money isn’t there. Against that, demands that we must spend more money and the rich can afford to pay.
Money is not the real problem
I am nearly 60. The progress and terms of this debate are familiar and wearying. We have heard it all many times before. Whichever side has the whip hand, things don’t really get any better.
Add in an inevitable new COVID panic in the Autumn and the picture looks bleak. What can we do to alleviate the gloom?
Money will solve nothing because money is not the problem.
“The first task is to make sure that there is enough demand to provide employment for everyone. The second task is to prevent a demand in excess of the physical possibilities of supply, which is the proper meaning of inflation.”
From a radio broadcast by John Maynard Keynes in April 1942. Consider for a moment the implications of engaging the wider public in a debate about post-war rebuilding many months before El Alamein signalled the “end of the beginning.” How the world has changed!!
Returning to the world of today. In healthcare, money is a mere instrument of exchange. It is not a measure or store of value. I would argue that costs and budgets and salaries are not the real indicators of inflation in the NHS. Picking up the thread of the great man’s argument, the best indicators of inflation in the NHS are waiting lists and delays in treatment.
Waiting and delays tell us how much the supply and demand for healthcare are out of balance. A lot right now. Fixing this is not about the mechanics of the lists themselves, just as fixing inflation is not about trying to fix prices. We tried that in the 1970s. Things got worse, not better.
More money is not the answer for the NHS
Attack the causes, not the symptoms. At the highest level, this means three main strategies:
Reduce the demand. Long term we can achieve this by helping people to lead healthier lives. All parts of our society and culture need to become more proactive on this front. Short term, the only solution would be charges for services, such as the fees paid for GP appointments in France.
Increase the supply. This is an order of magnitude harder. Yes we should train more nurses and doctors, but demographics mean we don’t have enough people. My solution to this, establish serious training facilities in other countries. Imagine if we trained thousands of clinicians in Rwanda to UK standards every year. Some of these people would stay at home and make health much better in the world’s most deprived continent. Other would emigrate to the UK and arrive fully qualified to work in our NHS.
Make better use of the people we already have. By contrast, this is the easiest thing to do. Digital technology is just a set of tools. The tools exist already. They are proven, efficient and cheap as chips. Despite many millions in poorly directed investment, our nurses, pharmacists and doctors have out of date, unhelpful tools. Give them better tools. Now. We will save money AND reduce waiting lists AND make life easier for our hard pressed NHS workforce.
Anyone who has read this blog before will know that Triscribe is 100% focused on being part of the solution to the last point. We are one of many. The UK is home to more innovative digital companies than any other country in Europe. Most are here and ready to help. Triscribe certainly is.
In a future post, I will deal with a different, more subtle inflation. The vast increase in the supply of data.
Until then, if you are interested in working with Triscribe to make life easier for clinicians in your hospital, get in touch firstname.lastname@example.org