Happy Birthday NHS: What changes are necessary, and how might we make them?

Tonight’s Slugger event is highly focused on health policy, for which we make no apologies. One poor feature of devolution in Northern Ireland is its retreat from policy in favour of populism. However, this is also a wider feature of western democracy.

About a year before the last but one UK general election, this animated conversation between Professor John Kay and Steve Richards illustrates the exact same casual (ie, uncosted) retreat taking place elsewhere:

In Northern Ireland (as elsewhere), there is, rightly, a lot of focus on patient outcomes. But there is very little corresponding effort to identify flaws within the system and almost no space to considering alternative solutions.

This despite the fact our healthcare structures are now carrying a demographic weighting it was never designed to carry. [Not the sort of demographic questions our politicians like to talk about is it? – Ed]. Er, no.

In 2016, Bengoa noted:

When the NHS was created in 1948, life expectancy was 65.8 years for men and 70.1 years for women. It is now 78.1 for men and 82.4 for women.

In terms of costs, users aged over 65 account for more than two-fifths of HSC spending – 42%, compared to their population share of 14%.

Whereas the average cost of treating a 55-59 year old stands at £1,970 per head, this rises to over £6,000 for 75-79 year olds and £14,000 for the over 85s.

The latest stats from NISRA in April of this year make grim reading:

  • One in four of the population here will be in 65 and over age group by 2041 (page 9)
  • Over the decade up to 2026, the population aged 65 and over is projected to increase by 25.0 per cent (page 25)
  • Over the decade up to 2016, the population aged 85 and over is projected to increase by 31.4 per cent (page 27)

It might actually be worse in England, where the breach between health and social care was made back in the early 70s. Nevertheless, our A&E services are in permanent crisis. The entire NI health service only keeps going by finding money between spending rounds.

One of the problems all elected politicians face in times of austerity is the shortage of permission to do anything too radical. When incomes are high, the government tends to have more cash, and people more willing to let them make the necessary changes.

Much change took place in Britain when the government was willing to spend liberally on updating a long-neglected public service. But this was a huge dividend missed by NI through one of several prolonged political hiatuses at Stormont.

Its timing for return in 2007 could hardly have been worse. Since 2010, almost every proposed reform (like using tax efficient sub cos for floating off NHS staff) handed down from Whitehall has been focused on spending less, rather than improving outcomes.

The daily Nolan Show on Radio Ulster maps the outworking of this almost every day in terms of the heavy price being paid by patients. The Detail website likewise.  Tonight’s debate will try to open up the discourse about causes and possible solutions.

Book your free tickets for the debate, details on venue etc can be found here:

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