ANALYSIS
Fig 5 | UK NHS spending as a percentage of gross domestic product (GDP): actual and growth projected at 3.4% per year from 1950 to 2100. Data sources: 1950-2018, NHS Funding and Expenditure Briefing Paper CBP0724 3 ; 2019-22, authors ’ estimates based on UK health departments annual accounts; projections, authors ’ calculations. From 2028-29 to 2072-73, real GDP growth as Office for Budget Responsibility long term projections. 15 From 2073-74 to 2100-01, real growth assumed to be 1.5% per year
by first defining what a high quality health service would look like: fast access, safe, “ consistently high quality care, in appropriate settings, with smooth integration between different types and settings of care … no bottlenecks between health and social care, with patients moving from hospital as soon as they are medically fit to do so, and a choice of residential or nursing home placement for patients who cannot be cared for appropriately at home. ” The bill, Wanless reckoned, would mean total (public plus spending by individuals on privately provided care) healthcare spending increasing from a then estimated 7.7% in 2002 to between 10.6% and 12.5% by 2022-23, depending on three future scenarios (fig 6). These figures included an estimate for private spending of 1.2% of GDP, with the increase overall being due to increases in NHS spending. In fact, we now know that total spending in 2002 was more like 7.9% than the assumed 7.7%.
Although these are long time periods, the bad news is that for economic and not least arithmetic reasons, at some point NHS spending growth in excess of GDP growth is unsustainable. At some point the curve must bend. Or, as the American economist Herb Stein noted, if something can ’ t go on forever, it must stop (Stein ’ s law). 16 Of course, bending the curve does not mean spending less on healthcare; more can be spent in real terms to obtain more of the things we value from healthcare (higher quality, better health outcomes, etc). Rather, it is the rate of growth that must, at some point, inevitably align with the rate of GDP growth. A more sophisticated attempt to answer the spending question and a heroic effort to bend the spending curve was the work of the Treasury team headed by Derek Wanless, initiated by the then chancellor, Gordon Brown, and published in 2002. 17 Wanless and his team of government economists set about answering the question
the bmj | BMJ 2024;384:e079341 | doi: 10.1136/bmj-2024-079341
5
20
Powered by FlippingBook