NHS requires radical rethinking to avoid “terminal collapse,” warns report

BMJ 2010; 340 doi: (Published 25 June 2010) Cite this as: BMJ 2010;340:c3430
  1. Bryan Christie
  1. 1Edinburgh

    The NHS will struggle to control costs as budgets tighten in the years ahead, marking the beginnings of a terminal collapse, warns a report that calls for radical new thinking to create a sustainable future.

    It says that the NHS has never experienced a protracted period of static funding in its 60 year history and that the current approach of marshalling limited resources in smarter ways to meet rising demand will not be enough to meet this challenge.

    The report is by the Scottish based think tank International Futures Forum (www.internationalfuturesforum), which was set up in 2001 with a grant from BP and works with organisations such as the British Council, the UK government’s Foresight Programme, and the Scottish government. The report says that health systems across the developed world need to find different ways of controlling ever escalating health spending, which has consistently risen at a higher rate than growth in the economy.

    Spending on health in the United Kingdom is now equivalent to 9% of gross domestic product (GDP), compared with 3% in 1948; and on current trends healthcare spending in the United States may consume 30% of its GDP by 2040. The report questions whether this is realistic or desirable.

    It examines traditional methods of controlling expenditure in the NHS, such as efficiency savings, increased competition, restrictions on activity, and freezing pay. But it concludes that these have “either been tried and found wanting in the past; will lead to considerable opposition from staff, the public or politicians; or cannot deliver at a sufficient scale to make any systematic impact. Without radical innovation, this is a system in a state of terminal collapse.”

    The report notes that high spending on health care does not equate with the best population outcomes. “Countries like Costa Rica and Cuba spend a fraction on health care compared with the UK yet have life expectancies not far short of ours. The US ranks 41st in the World Health Organization’s league table of maternal mortality yet spends more than any other country per capita on health care. Spending more money is not the same as ensuring adequate and affordable care for all those who need it,” the report says.

    Its main conclusions are that:

    • The inexorable rising trend in healthcare spending to meet demand is fundamentally unsustainable

    • Existing strategies to contain spending have been ineffective and have led to undesirable knock-on consequences, and

    • Further innovation to make the existing model work better merely postpones the system’s inevitable decline and collapse.

    The report argues that low cost solutions such as helping people to develop their own capacity to cope with illness may be more important than fighting disease.

    “The NHS has never had to face a financial challenge of this magnitude in the past. We believe the present faith in stricter or more innovative financial management on the one hand and reducing demand for NHS services on the other is naive and potentially damaging. It provides false hope, and closes down any serious debate about radical options for longer term transition to a more sustainable model. More radical thinking is urgently needed.”


    Cite this as: BMJ 2010;340:c3430