UK: WHEN MONEY AND HOSPITALS CAN'T CURE ALL ILLS.

UK: WHEN MONEY AND HOSPITALS CAN'T CURE ALL ILLS. - Nothing better illustrates the gulf in perceptions about the NHS than the furore over hospitals. For the British, the NHS is hospitals.

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Last Updated: 31 Aug 2010

Nothing better illustrates the gulf in perceptions about the NHS than the furore over hospitals. For the British, the NHS is hospitals.

The snag is that their distribution is uneven, their location in the centre of big cities a handicap, they are hugely expensive and getting more so as advanced technology and new drugs multiply treatments and demand, and considering they account for around one-tenth of all public spending, add little to the health of the country.

So, as in other countries, UK governments would like to reduce pressure on hospitals to cure people by preventing them getting ill in the first place.

Concentrating hospital provision into fewer and more efficient modern centres, they hope, will allow resources to go into primary care. Britain is actually well advanced along this route (set out in the WHO's Health for All).

Unfortunately, the changeover has hardly started. While the last decade has seen the loss of 100,000 beds in England and the startling total of 300 hospitals shut since 1990, hospitals continue to absorb a growing share of health spending - and primary care is particularly poor where it is needed most, in the big cities.

The result is a nasty Catch-22. Hospitals are too full to be shrunk any more, while GPs are ill-equipped for the explosion of demand which a primary-led system will entail. Meanwhile, the (separate) social care system which is meant to support the elderly and mentally ill at home is overstretched - putting fresh pressure on hospital beds.

Spending more money would inject much-needed slack into the system. Beyond that, money is not the obvious answer it seems. Medical intervention has surprisingly little effect on overall health. Life expectancy depends more on lifestyle than on proximity to a big hospital. Giving people jobs is of more benefit than doubling NHS spending. Despite hospitals' high profile, the health of the NHS depends on its finding alternatives to treatment in the acute sector.

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