The NHS will be unable to provide new and advanced treatments unless policy makers take steps to mend its long term financial position, warns Harry Quilter-Pinner

Today, one in three babies born in the UK are expected to live to 100, up from just 1 per cent of people born a century ago. This staggering increase in longevity and health, described as the “great escape” by Nobel Prize winning economist Angus Deaton, has been experienced to varying degrees across the developed world. 

Better sanitation, improvements in nutrition, comprehensive health and care systems: all of these factors have played starring roles in this astonishing story. 

Advances in science

However, the most significant driver has been the steady march of scientific progress. According to some academic studies, as much as 50 per cent of the global health gains can be traced back to the invention of new treatments and innovations. 

This makes a huge amount of sense. From imaging and anaesthetic technology, to anti rejection drugs, artificial joints and fibre optics; even a brief survey of the last 50 years shows what the scale and scope of these changes in healthcare can deliver. 

Whilst the potential gains made possible by science and technology are huge, there is no guarantee that everyone will benefit from them

This finding is good news because if the optimists are to be believed, we are in the process of another significant leap forward. Big data will transform our ability to diagnose patients. Genomics will lead to more effective personalised interventions. And robotics will replace human surgeons, reducing the chance of errors.

However, whilst the potential gains made possible by science and technology are huge, there is no guarantee that everyone in the general population will benefit from them. Just ask those who live in the developing world, many of whom struggle to access even the most basic treatments that have been available in the UK for decades. 

This gap – between what we know and what we do – exists, to varying extents, in all health and care systems. The UK has historically been considered one of the better performers, although unlike the US it has balanced this with a rigorous assessment process; led by the National Institute for Health and Care Excellence, which ensures that new treatments are a good use of the taxpayers’ money.   

Affordability test

Nevertheless, there is a growing consensus that in the NHS this gap is starting to grow. The most obvious example of this is NHS England’s recent decision to introduce a new “affordability test” for new treatments. This will mean that some treatments which are deemed “cost effective” by NICE will still not be available on the NHS because they are deemed too expensive, with up to 1 in 5 new drugs potentially impacted.

Even prior to this announcement, there were a number of high profile examples of this kind of rationing. The British Medical Journal recently found that the NHS has systematically attempted to limit access to some Hepatitis C drugs, whilst the NHS in England (though not Scotland) has also, so far, refused to provide patients ground breaking new HIV treatments such as PrEP.

Some treatments which are deemed “cost effective” by NICE will still not be available on the NHS because they are deemed too expensive

So how do we go about reversing this trend? Last week, the Association of the British Pharmaceutical Industry announced that it was applying for a judicial review of the NHS’s new affordability test. This is certainly one way of approaching the problem but the reality is that, win or lose, the NHS will continue to fall behind the curve, unless the underlying pressures behind these decisions are addressed.

Fall in NHS funding

At heart, this gap is a manifestation of the government’s decision to cut back funding for the NHS. Since 2010, spending on the NHS in England has grown by just 0.9 per cent. Compared to most other public services, which have experienced an absolute cut in funding, this is generous, but it is well below trend, which sits at around 4 per cent given our growing and ageing population. The result is that this will have been the NHS’s most austere decade ever. 

Since 2010, spending on the NHS in England has grown by just 0.9 per cent

Over this period, policy makers have tried everything to deliver “more for less” with the Nicholson Challenge and the current government’s Five Year Forward View aiming to drive productivity growth. However, the increase in rationing of innovative new treatments, alongside the ballooning NHS deficits and rising waiting times, are signs that we have reached the limits of this strategy. 

The hard truth is that without a long term financial settlement for the NHS – that recognises the underlying pressures on the system as well as the huge opportunities presented by increased investment in the future – it will fail to “keep up with the science”.