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NHS needs reform, not just more cash

Bill Blain
July 20, 2020

The bottom line is we simply can't continue to pay for the NHS as it currently operates. It's just not efficient. It no longer delivers. It needs fundamental reform to meet its goals of better health, care and value, argues Bill Blain 

The UK is immensely proud of our National Health Service. Every street has at least a couple of rainbows in the windows, and we diligently clapped our hospital staff through the lockdown. We won. We opened 5000 bed Nightingale hospitals in just a few days, and the NHS was never overwhelmed by the Coronavirus.

But, now a more sobering assessment is underway. The virus didn't beat us, but at what cost? Hospitals were effectively shut down and didn't treat other medical conditions as all resources were marshalled to fight COVID. Cancer and heart-disease sufferers were triaged in favour of Covid patients.

The authorities were acting on the scientific advice, but it's increasingly apparent the NHS was ill-prepared for crisis – despite war-gaming a pandemic just a few years ago and learning PPE stocks were critical, I've been told Army specialists found NHS England logistics planning to be non-existent.

The NHS has a very simple mission statement – to deliver better health, better care and better value. Sadly…. None of it is happening.

Our doctors, nurses, care workers and hospital staff are genuine heroes, but successive Governments have shirked the NHS's growing costs and mission drift. It's become a political football, the UK's most sacred of sacred cows. Any proposal to reform, restructure or redirect is immediately pounced upon by unions and opposition as a threat, privatisation, or betrayal. It's impossible to discuss or critique the NHS' costs in any sane or rational way.

It consumes money at a terrible pace, yet any doctor or nurse can quickly tell you just how inefficient it is. For a service that's supposed to alleviate suffering, it seems to take ages for anything to happen. It's become a bureaucratic monstrosity overseen by multiple layers of overpaid (and over-pensioned) managers who hide their accountability behind ministers.

The bottom line is we simply can't continue to pay for the NHS as it currently operates. It's just not efficient. It no longer delivers. It needs fundamental reform to meet its goals of better health, care and value. Is any politician "courageous" enough to propose it?

For a start, reform might focus on how society has changed these last 73 years since foundation. Care provision is now dominated by the needs of the elderly – and that's not free. The real reason so many care-home residents died of the virus is because private care homes operate on miniscule budgets and are forced to rely on agency staff who work in multiple care homes. The story of how a home in Skye lost residents after hiring agency staff from London is particularly revealing.

Health is now largely about prevention, and that's where a more modern approach to diagnostics and treatment would work. If we all owned our medical data – stored on our phones, or even a sub-cutaneous chip, and kept that information updated with the results of every test, blood sample and readings from our wearable tech, then medical AI would quickly be able to work out what our symptoms mean.

Instead of clinicians wasting time and resources searching for the needle in haystack of what might be wrong with us, the AI would be able to point immediately to the most likely causes, and then coordinate care and treatment delivery. Imagine if AI was able to learn from the data from all us… we'd very quickly have a focused, targeted, effective NHS. We'd be able to direct resources directly into doctors, nurses and therapists, targeted treatments, and understand more fully the efficacy of drugs and therapies.

The tech magic to do all this already exists. The problem may be we've missed the boat. Big tech is already collating the data – and owns it. Rather than using our data to protect us, it will be used against us – charging more for insurance on the basis of genetic flaws. Google and others have already written the algorithms to predict our health. They expect to be able to monetise it.

A rethink and refocus on what and how the NHS works is critical. And cost has to be part of that discussion.

Bill Blain is market strategist and head of alternative assets at Shard Capital. He has a 35 year career in financial markets behind him, in capital markets and fixed income. After the last financial crisis, Bill wrote a book called “The Fifth Horseman: A Polemic on how to destroy the Global Economy - and other matters”. He writes a daily market commentary called The Morning Porridge (
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