The NHS will be privatized in 2020

England: tradition meets reality

Free health care for everyone. The National Health Service of England has been making history with this motto since 1948. The British pride themselves on this philosophy, but the National Health Service (NHS) is increasingly making negative headlines. Reforms are underway. As is so often the case, there is one thing that is lacking in particular: money.
From Nora Schmitt-Sausen

It's always such a thing with studies, surveys, and statistics - even if they come from a reputable source. Last summer, a survey by the Commonwealth Fund made people sit up and take notice. The US-based and internationally respected foundation named the NHS the best healthcare system in the world. “The UK ranks first overall. It achieved the highest scores for quality, access and efficiency, ”the report says. For the report, the health systems of eleven industrialized nations were examined and compared with one another; In addition to Great Britain, these included the USA, France, Germany and the Netherlands. Information from patients, doctors and the World Health Organization was evaluated.

The British were of course happy about the positive result. Mark Porter, chairman of the British Medical Association, commented in the "Guardian" delighted: The results are "clear evidence that our much maligned NHS is one of the best performing health systems in the world." Less than a year later: another study, another result . “The Economist Intelligence Unit”, a research institute of the British media company The Economist, comes to only one conclusion in a comparison of 30 health systems, namely that the United Kingdom does poorly in an international comparison. The writers almost give the NHS the red lantern; they place him in 28th place. The aspects of financial means, resources, and treatment results were examined. Conclusion of the report: The British system lags significantly behind other countries in terms of doctor density, nurses, hospital beds and equipment (see box).

NHS: not fit for the future

For the authors of this study it is clear: the NHS is not fit for the future. And you are not alone with this opinion. In England everyone knows by now that the NHS engine is no longer running properly. Rather, the health service itself has become a complicated patient. And the outlook is not good: According to its own forecasts, the English health service has a financial shortage of up to 30 billion pounds in the near future. Above all, the shortage of funds fueled by the financial crisis paired with the increasing demands due to demographic change are affecting the system. Fatal supply problems are already becoming more and more common. Emergency medicine in England in particular has made devastating headlines in the recent past. There are regular reports of patients having to wait hours in the corridors of the emergency rooms to receive treatment; there have already been several deaths.

Politics under pressure to act

The national health service was one of the central issues in the election campaign this spring. But for the political elite, system corrections are a tightrope act, because the English revere their system, which enables them to receive almost free care from taxpayers' money. In England, the status of the NHS is not infrequently equated with that of a religion. All parties promised not to touch the principle of state health care for all citizens and to spare the NHS further budget cuts. Even after the election, contrary to many fears, these promises will probably hold up. David Cameron reiterated that the NHS budget would not be cut despite the empty state coffers.

Recent efforts to reform the NHS have so far shown no impact. In 2010 and 2012 the government initiated a massive - very controversial reform - according to which the foundations of the NHS were to be changed. The approaches (for example: more competition and privatization, decentralization, reduction of bureaucracy, more power for doctors) caused overall more chaos than they used; in the meantime, even former proponents have refrained from it. The British press is sometimes hard on British health policy. The “Economist” even speaks of a “political disaster”.

More prevention, fewer large hospitals

Today there is little hope that reform efforts will be more successful in the future. That hope bears the name of Simon Stevens. Stevens has been the new head of NHS England since April 2014. Just six months after taking office, he presented a five-year plan in which he outlined the future route for the NHS.

The NHS chief suggests massive investments in prevention and public health as well as patient self-management. Treatment-intensive diseases such as diabetes mellitus should not even become a problem in the first place. As in many other industrial nations, the widespread disease also causes high costs in England. The NHS currently invests ten percent of its budget in the treatment of diabetes mellitus alone. Another core element of the plans is to shift patient care more to the local level and to better network medical staff and care providers. In plain language this means: Stevens wants to tear down long-standing boundaries between general medicine and the hospital sector as well as the health and social sector. Local, integrated, personalized and cost-effective - this is what Stevens' vision for England will look like in the future. Stevens believes that only by making these course corrections - long requested by some - will the NHS be able to meet the growing needs of an aging population.

Stevens is well aware that this path will not be easy. But it leaves no doubt that action must be taken. "The pressure on the system is increasing and long-standing problems will not go away overnight," he said in his inaugural address. And he puts it clearly in a nutshell what some have long shied away from saying: The coming years will be “a challenge of a magnitude for the NHS that the system has never seen in its long history”.

The NHS at a glance

UK healthcare is still synonymous with progress in some parts of the world that rely on public health systems. The NHS provides the population with comparatively high-quality and largely free care - financed from tax revenues. The NHS England has an annual budget of £ 113 billion. England, Scotland, Wales and Northern Ireland organize their systems independently.

The facts: According to the OECD Health Statistics 2014, the United Kingdom spends 9.3 percent of its gross domestic product on health - an average figure in an OECD comparison; however, less than is applied in many other European countries. In the wake of the financial crisis, investments were also much lower. The NHS suffered the deepest cuts in its history. A special feature of the system: 84 percent of the funds come from public funds alone. The OECD average is just 72 percent.

The UK started training more medical staff in the 2000s to strengthen its primary care system and reduce reliance on foreign doctors. The result: Today there are 2.8 doctors for every 1,000 residents; in 2000 it was only 2.0. According to the OECD, access to care has improved as a result of this increase in staff; At the same time, however, the pressure on costs increases. There are 8.2 nurses for every 1,000 residents; the OECD average is 8.8. A dramatic picture emerges when looking at the number of hospital beds. There are only 2.8 beds for 1,000 citizens (OECD average: 4.8).

One of the central consequences of the personnel key is long waiting times for appointments and treatments - both in medical practices and in hospitals.

© Österreichische Ärztezeitung No. 17 / 10.09.2015