Can the new government fix the NHS? | IFS Zooms In

Over the next few weeks, we’re bringing you a series of briefings looking at key areas of government and analysing how they have performed over recent years, what challenges they face and which solutions are on the table.

This week we'll start with the NHS - the UK's biggest public service.

We're joined by Ben Zaranko and Max Warner, IFS experts, to discuss the big challenges facing the NHS, and what the new government will do about them.

[Uneducatedopinion]

Most people in the comments have no clue what they are talking about, yet feel confident in giving out solutions, that’s the real problem

[MKhosla-wbbf]

Government must also change its Health Act framework - it is large part of reform needed to NHS and social care. Private equity investors supplying to NHS are also a factor for 11% productivity issues, these firms marginalise output for profit gains from public NHS funding.
Collectively- a lot can be done to improve productivity at NHS - but bureaucrats will not allow it. It must be tackled putting aside political choices at expense of tax payers.

[stepheng]

The only way to deal with an aging population and a working age population with comorbidities, is to place greater emphasis on primary care and bring social care into that primary care sector. The lack of joined up thinking, planning and action means that people get passed through to different services:; each doing their little bit, coming to the same conclusion but failing to provide sufficient support. Consequently service users/ patients only get part of a solution and underlying problems do not get solved. They then end up in acute health care, which has to deal with the inevitable crisis.

[jonathannankivell]

The National Institute of Health and Care Excellence (NICE) is a UK body that determines clinical guidelines. When they publish their clinical guidelines, they also publish a list of research questions they would like to see prioritized. These questions are tightly focused on clinical relevance, they are well-defined and they are currently unanswered in the clinical literature.

Every few years NICE reviews the clinical literature, checks if their recommended studies have been run and, normally, move on disappointed.

It's not hard to design studies that answer NICE's research priorities. These studies wouldn't be unusually difficult to do. But somehow the studies which NICE claim would affect the clinical care they recommend UK hospitals provide do not get ran.

It is embarrassing that despite the Government giving out 5bn GBP per year for health research, the questions that NICE most want answered do not get answered. Please fix.

[annabelmacrae]

What about bed blocking? A functioning care plan is essential to freeing up beds so that patients move on through the system.

[russellwild]

we don't have enough medical university places and a lot of them are given to foreign students when we have a backlog of people wanting in the UK wanting to be doctors, nurses etc...

[Xxj-yn]

Although it's not the NHS as such but my GP surgery recently managed to send me 5 months supply of my drugs in 6 weeks. I told them at the start their system was failing and finally 6 weeks later they claim they have got it sorted and that I should take the 5 months tablets they have over suppled to a pharmacy to have them destroyed! I will not be doing so as I have an alternative that will save the taxpayer money. To say the staff are useless is a understatement.

[MENSA.lady]

The NHS has no competition, that's the problem. Give the population the option of opting out of the NHS and making their own arrangemts and progress can be made.
N.B. It is essential to stress that if you opt out and fail to make your own arrangements the NHS will NOT bail you out if you get sick.

[MKhosla-wbbf]

NHS productivity levels can be addressed by reducing the unnecessary pathways generated over the past 3 decades. Of course each condition is different but over 50% of NHS staff being admin we could staff there E.g.. 1 referral to see an eye doctor has three different pathways with 4 members of staff before seeing doctor 2 hours later - so to put into context by streamlining process using technology and increasing skills of doctors operating more efficiently with 1 technician vs. 4 technicians we may see improvement in outputs become more efficient.

[ciaranquinlan]

Another very helpful video and some great talking points for us all to take on board

[MKhosla-wbbf]

Also why are so many doctors doing research vs. Working frontline? Ask the NHS to issue their resource plan and you will see how over staffing resourced 1.4 million FTE!

[jonathannankivell]

I wonder what how the IFS respond to Robin Hanson's paper Buy Health, Not Healthcare. Cato Journal, Vol. 14, No. 1 (Spring/Summer 1994)

If you implement the basic proposal but have the central government paying the insurance premiums to the LMOs, you would have a free at the point of care healthcare system, but where incentives are aligned with cost-effective patient health all the way down.

I'm nerd-snipped - what do y'all think?

[cchan]

Look at the pension and use of contractors

[adtastic]

I'm an Australian healthcare worker that worked in the NHS for 13 years and I can tell you quite easily why it has productivity problems. It's because if you pay peanuts you get monkeys. Quality staff leads to quality service and I saw some pretty poor practice over in the UK. Practice that would get you fired in Oz seems to be brushed under the carpet because they can't get anybody else to do the job. Healthcare is hard and you can't just get anyone off the street to do it. The type of people you need to run a functioning system usually have other options than to be poorly paid and overworked in the NHS. Now the Govt thinks they can replace British staff with foreign staff that they don't have to pay as much. I worked with a bunch of these foreign guys and some of them have never used a computer and if they have they only used equipment that's 30 years old. Your basically retraining them from scratch. You add to that sort of thing the lack of competition or a profit incentive and there's no reason to improve. Work Im expected to turn round in a few days in Oz, I got 2 weeks in the UK. And even then they don't care if patients get postponed.
Personally, I don't see nothing improving. I saw it only going downhill 10 years ago and I've been proved correct. That's why I emigrated to the US. And the reason it's never gonna improve is because the British public has annointed the NHS to some saintly status where it's perfect in every way and any attempt at common sense reforms, to bring it in line with all other health systems, are easily exploited by vested interests and amount to political suicide for any politician who dares try.

[NMA-illu]

I am not sure whether the employer has as much bargaining power as assumed. The UK is dependent on importing medical staff. It is no longer an inviting place for EU staff, work permits etc., or even Irish passport holder around pay and conditions. Added to this, existing staff are leaving for say Australia, New Zealand, Canada etc. The panel mentioned that the recruitment of staff from India and Nigeria may be causing short-term? productivity issues. Experienced medical staff are internationally mobile, the competition is not just from the developing private sector.

The other issue is prevention. Making people healthier for longer, ensuring that they do not need medical treatment. A decline in road accidents and their severity by say 10% would free up tens of thousands of bed nights, out patient clinics A&E units etc. This is dependent on enforcement (policing cutbacks), slowing traffic and reducing speed limits. It seems difficult to see how improvements can be achieved without looking at other areas of Public Spending and seeing pay as an international issue, when you employ a multi-national workforce.

[alexblue]

The good news for the people who posted on Facebook and YouTube and get sent to prison it's about the only chance they have to see a doctor in Britain

[georgethompson]

The nhs was a service which worked for 50 million but has struggled since the population has grown. Try counting the number of hospitals and extra bed capacity since the 80’s.

[paddycoleman]

I am sorry but the biggest issue the NHS has is dental care or the lack of. The nation’s teeth are getting progressively worse and this will lead to serious health problems later on. These knock on illnesses etc. will then be picked up by GPs and hospitals at far greater expense. NHS Dentistry is a disgrace. Need to hear more people and politicians raising this issue.

[thatguy]

Hmmm, this was an odd collection of ideas.
Productivity in public services is an incredibly hard metric to attain. It was talked about as a private sector measure. Public and private sector productivity measures are not the same.
If you reduce class sizes in schools and produce a better educated work force, productivity fell from educating less students with the same pay. Those students add more value to the economy with a big lag and the quality isn't captured in the nominal productivity measure.
The talk of financial pressures without the inclusion of marginal benefit was a novice approach. Public sector goods are no longer prudent when marginal benefit = marginal cost.
Im not sure if you dumbed the conversation down for the upload audience, but it was painfully adolescent.

[raki]

all the so called stimulus overwhelmingly went to the rich, tax that back and fund public services