Misuse of information in discussions about the spending and performance of the NHS is all too common: the future of the NHS relies on getting the basic facts right.
Correcting false information about the NHS would be a time-consuming task if anyone was inclined to take it on seriously, since there is so much of it.
Some of it originates in NHS England itself. Take for example Chief Nurse Jane Cummings’ recent claim that patients were missing “£1bn worth of appointments” and that “the money wasted could fund 1m more cataract operations or 250,000 hip replacements”((https://www.theguardian.com/society/2018/jan/02/patients-missing-their-appointments-cost-the-nhs-1bn-last-year)). As Professor Andrew Street pointed out on Radio 4’s “More or Less” programme, the figure of £1bn was arrived at by multiplying the number of missed appointments by the cost of a kept appointment (estimated at £120), a mistake so elementary that you have to question either the competence or the integrity of those who made it. Allowance for missed appointments is built into appointment lists in the same way that allowance for ‘no-shows’ is built into airline bookings systems – the cost of a missed appointment is close to zero. Yet the chances are that a lot people now think missed appointments are a costly problem (false claims “fly half way round the world while the facts are getting their boots on”).
Some dubious ‘facts’ originating in the Department of Health are so routine that commentators routinely fail to point them out – for example the claim that the government is spending “more on [mental health, children’s services, or whatever] than ever before”. It is more or less unheard of for a commentator to point out that the population is bigger than ever before, and that such claims on their own are worthless.
Another kind of error which is more serious, and for which media commentators are directly responsible, concerns comparisons between the NHS and other countries’ healthcare systems. A good example occurred ten days ago when President Trump claimed that the 60,000 people who rallied in London to call for adequate funding for the NHS were protesting against the UK’s “broken” model of universal health care((https://www.buzzfeed.com/markdistefano/trump-farage-nhs?utm_term=.sr0wmRqBP2#.rgVvWO5R3d)). A response in the Guardian on “What Americans need to know about the UK’s health system” emphasised the NHS’s great merit of being free at the point of service, but added that “despite its popularity, the NHS performs roughly mid-table in terms of bang for its buck: some countries spending roughly the same on health get considerably better outcomes…”((https://www.theguardian.com/commentisfree/2018/feb/05/americans-uk-health-system-trump-nhs)). The same assertion was made in an article published just days earlier, by ITN’s Europe editor James Mates, entitled “Why aren’t European hospitals facing a ‘winter flu crisis’ like the NHS?”. The reason, according to Mates, is not better funding but continental Europe’s social insurance model of financing: “The UK now spends around 9.9% of GDP on health, very slightly below the EU average. Germany spends 11.1% or so, not a massive gap… just across the Channel, a number of countries with a similar social system and spending similar amounts of money seem to be managing health care rather well” (i.e. by implication, better)((http://www.itv.com/news/2018-01-31/why-arent-european-hospitals-facing-a-winter-flu-crisis-like-the-nhs/)).
But this is a misuse use of data not all that different from Jane Cummings’. To describe the difference between the percentage of GDP spent on healthcare in Germany and in the UK as ‘not a massive gap’, and to claim that the two countries spend “similar” or “roughly the same” amounts of money as some other countries with better outcomes, is too badly wrong to be a forgiveable mistake. The difference between the share of GDP spent on healthcare in Germany and that in the UK is, as Mates says, 1.2 percentage points. If the UK spent an additional 1.2% of our GDP on health care it would mean roughly an extra £26bn a year for the NHS, more than enough to close the funding gap and completely eliminate winter beds crises.
Moreover Germany is a richer country, so the difference in the share of GDP spent on health care translates into an even bigger difference in spending per capita. In 2016 Germany spent $5,551 per person (in parity purchasing power dollars), compared with the UK’s $4,192 – nearly a third more((http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en#.Wnq7Z_nFLIU#page135)). As well, the UK is a markedly more unequal country, with a Gini coefficient of 0.36 compared with Germany’s 0.289, and a ratio between the income share of the top 20% of the population to the share of the bottom 20% of 6.1, compared with Germany’s 4.4((http://www.oecd.org/social/income-distribution-database.htm)). Since poverty is closely related to ill health this means that the UK’s burden of illness is greater. Even if the UK spent as much on healthcare per head as Germany does, it would not go as far, or necessarily get such good statistical outcomes. And what is true in relation to the comparison between the UK and Germany is also largely true in relation to the other OECD countries referred to.
An honest debate over the future of the NHS needs such basic facts to be respected and kept in view. A forthcoming briefing by the CHPI’s Vivek Kotecha will provide a checklist of basic economic and financial relationships that commentators, and indeed the Department of Health and Social Care and NHS England too, may find helpful when making international comparisons between the NHS and other healthcare systems.
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