I lead Arup's global healthcare business. This...
With debate raging in the UK about legislation to introduce the private sector to the National Health Service (NHS), now might be a good time to ask what value we place upon healthcare. And of course, the answer to that depends upon where you live.
In the US, the Affordable Care Act, which came in to force on 1st January this year aims to provide a more efficient and sustainable health care system, and yet it still costs around £4,600 per person each year. In India and China, the cost of provision is around £21 and £89 respectively. In the UK, it is estimated that the NHS costs each person in the UK £2,320 per year, and that covers emergency care, primary and secondary care, prevention and treatment for long-term conditions.
The important difference between the UK and the other countries mentioned is that the standard of healthcare available is unrelated to the wealth of the individual. I believe that this is the right way round, that healthcare, education and law and order is the primary responsibility of the state and should therefore be dependent on the wealth of the nation, not of the individual.
And if you look closer at the NHS – and the value that it provides – you see that the success of the NHS is that it’s more than the sum of its parts. If private providers cherry-pick routine operations, then trainee surgeons no longer have straightforward operations on which to hone their skills, and the services left within the NHS could therefore become more expensive and less safe.
I can’t see a private provider making a success of Accident and Emergency (A&E) services given the degree of uncertainty in this area; it’s too difficult to streamline. So the NHS would be left to cope with the most difficult, chaotic parts of the service – like providing ambulances and emergency care.
Of course there are things the NHS can do to reduce costs without compromising care, improving the way that best practice is transferred and making better use of technology for a start. But the NHS in its current form has been admired, envied and copied around the world, so perhaps the answer is that we don’t place enough value on what we have already.