- Is demand on the NHS increasing?
- Why is demand increasing?
- Is the NHS really under pressure?
- Does the NHS need more funding?
- Is an NHS funding increase affordable?
- Is the NHS being privatised?
The UK population has increased by 10% 2003-2015, and the number of people aged 85+ has increased by 40%. But there are many other factors driving increased demand and costs, such as an increase in the number of people living with chronic health problems, more and earlier referrals by GPs for suspected cancer, and new technologies that allow treatment of previously untreatable conditions.
Historically, the NHS has required an average year-on-year funding rise of 4% to meet increased demand and costs. The Office of Budget Responsibility projects that a 4.3% increase will be needed going forward. But the NHS is not alone in needing funding increases - the OECD forecasts upwards healthcare spending pressure affecting countries worldwide.
In contrast, the Department of Health budget is scheduled to grow by only 1.1% per year between 2009/10 and 2020/21. This mismatch between demand and actual funding has led to the deterioration in key performance figures mentioned above.
OECD figures indicate that UK per capita spending on healthcare was near the OECD average, and was less than that of France, Germany, Belgium, Switzerland, Ireland, Canada, the Netherlands, and of course the US. This suggests that the NHS is actually relatively good value for money. Also, it suggests that caution should be taken when comparing the NHS with, for instance, the Netherlands.
The OECD predicts that the increase in funding needed to sustain the NHS through to 2060 would be 6% of the UK's Gross Domestic Product (GDP), taking the spend from the current 7% of GDP up to around 13% of GDP in 2060. Considering that the US healthcare spend is already at 18% of GDP, it is difficult to argue that this is unaffordable.
In a word, yes. The World Health Organisation defines privatisation as "a process in which non-government actors become increasingly involved in the financing and/or provision of health care services." This is indeed happening in the NHS.
10% of the NHS England budget is now spent on care provided by non-NHS bodies, including non-profits and private firms. Department of Health figures show that 7.7% of day-to-day NHS funds went to private firms in 2016/17, compared with 6.3% in 2013/14 and 2.8% in 2006/07. In addition, £0.94bn was spent on PFI payments in 2016/17. Private firms won 70% of tendered contracts from NHS England in 2016/17, and the total value of contracts going to the private sector jumped from £0.7bn to £3.1bn.
There's also the concerning matter of more patients paying for private treatment within NHS hospitals. NHS acute trusts made £583m from private patients in 2016/17, up from £487m in 2012/13.