I stumbled on a way of thinking about NHS budgets the other day which I hadn’t previously encountered.
Forgive me, I lead a sheltered life. But an LSE health economist called Zack Cooper advised primary care trusts to start talking about “decommissioning” services. Cooper’s complaint is that this arises because their budgets are set.
America always manages to surprise
“Unlike any other organisation in the world, they don’t have to worry about raising money,” so they go into budget meetings wondering what to purchase with the extra dosh, he said.
Before you explode with righteous indignation, didn’t at least one PCT chief get cross after Andrew Lansley boasted on the radio that his budget would always go up under the Tories? It undercut the PCT chief’s warning to her staff: “The money has run out and it is time to do different things.”
Both points arose out of a roundtable discussion in which health secretary Andy Burnham and assorted US-UK luminaries (plus me) took part at Westminster under the aegis of the New Statesman magazine.
The general idea was, what could we learn from each other? But one thing which was striking to me was that the US experts talking down the squawkbox from Washington were not much inclined to defend their own costly, unfair system. Nor were our own free market think tankers from Policy Exchange and Reform.
For me two new “facts” leapt out about the US experience. Everyone, from Handy Andy down, agreed the best of high tech US medicine is the best and we all have much to learn from pioneering ways of managing long term care.
But shocker fact No 1 was that 60 per cent of the 47 million uninsured Americans are aged under 35, many of them people who have chosen not to insure, it was claimed. A further 22 per cent are illegal immigrants who do not qualify for any of the $700bn a year the federal government spends on the poor and old - Medicaid and Medicare.
That’s a helpful context. But it doesn’t change the 22,000 avoidable deaths among the uninsured each year, nor the 700,000-800,000 personal bankruptcies arising from healthcare bills; all the result of an anti-government mindset, according to US journalist TR Reid, whose Sick Around the World documentary made him very pro-NHS.
Shocker No 2 was more positive. Pfizer’s Anthony Principi explained that the US Veterans Administration is a model of progressive care. It has moved from a hospital-centric approach to a preventive, patient focused system, a pioneer in electronic records and primary care.
Well, I never. Despite all President Obama’s problems with stalled healthcare reform (Pfizer backs him by the way), America always manages to surprise.
What did I learn about us? Well, Burnham, cancer tsar Mike Richards and others were surprisingly adamant that less NHS money must not mean worse care and that it can be done.
“We need to learn from America to become more preventive and people centred,” said Burnham.
Earlier diagnosis is vital, said Richards. Healthcare is responsible for about 10 per cent of treatment for mortality; behaviour (ie, lifestyle choices) for about 40 per cent, said Cooper. Primary care is most cost effective, they all agreed.
So was all that investment in new hospitals after 1997 a mistake? I asked Burnham. No, we had to improve hospitals then. Now we can take services out. Fifty cents of every US health dollar spent adds no value to the process, an American admitted.
“Your problems are so much smaller than ours,” said Reid. “You have better results and you spend half as much. We would love to have your problems.”