The End of the NHS?

Panel session at the 2017 Festival of Economics, Bristol, chaired by Hugh Pym

  1. Last day of #economicsfest speaking about robots, gigs , inequality and NHS
  2. About to chair debate on future of NHS @FestivalofIdeas with health economists - short term financial needs and long term direction #economicsfest
  3. .@khcheck is a GP as well as a prof, says her NHS experience since 1980s has been feast & famine, & now it’s famine #economicsfest
  4. .@khcheck says squeeze in NHS finances means the most important metrics are "dropping off a cliff" #economicsfest
  5. Waiting times up & outcomes are dropping off a cliff at the moment. High GP workloads mean productivity is up! @khcheck #economicsfest
  6. Tax is a price we pay for living in a civilised society, is @khcheck’s closing quotation on future of NHS #economicsfest
  7. Checkland: freeze in NHS salaries 2010 onwards prevented disaster but meant big drop in real wages for nurses & other staff. #economicsfest
  8. Carol Propper highlights great variation in performance in the NHS, & that the reasons aren’t really understood #economicsfest
  9. Carol Propper: hospitals vary greatly in what they achieve with same money, same patient mix. #economicsfest
  10. Carol Propper highlighting future staffing crisis in NHS, because of ageing workforce & especially because of Brexit #economicsfest
  11. Propper: large proportion of NHS staff come from overseas. Hence NHS staffing crisis and Brexit are inseparable. #economicsfest
  12. When NHS under pressure some people use private services, and this threatens political support for NHS, says Carol Propper #economicsfest
  13. Strong support in UK for NHS & it’s efficient & cost effective, but we need to change how it’s managed, says @CastelliAdriana #economicsfest
  14. Change needed because of ageing population with chronic conditions, needs link to social care funding too, @CastelliAdriana #economicsfest
  15. It’s nice not to be the gloomiest person on a panel, says @PJTheEconomist on the NHS! #economicsfest
  16. .@CastelliAdriana : healthcare needs are different now from when NHS founded. More chronic conditions, more of population with medical needs. #economicsfest
  17. .@PJTheEconomist says 1/3 of government spending goes on health/social care. NHS not an organisation so much as a sector #economicsfest
  18. The NHS doesn’t deserve our hero worship: we need to ask how it can change for the better, @PJTheEconomist #economicsfest 
  19. .@PJTheEconomist : to keep the NHS we recognise, we have to find more tax money, or cut other public services, or (miraculously) make care much cheaper. #economicsfest
  20. All developed economies facing same cost pressures on health costs - we have to decide how much we want to spend and where from - @PJTheEconomist at #economicsfest debate
  21. Propper: ring fenced money for NHS means that, in tough times, other essential services are especially squeezed. #economicsfest
  22. Bed occupancy of over 95% in NHS is actually inefficient, limits ability to manage effectively, says @khcheck #Economicsfest
  23. Carol Propper says Netherlands is the one country to have integrated successfully health & some social care. #economicsfest
  24. Propper: Netherlands an example of success in integrating funding of health & social care; less of a political football than the UK. #economicsfest
  25. Audience question: would user charges discourage overuse of NHS services? Propper: they discourage the wrong kind of users/usages such as preventative care. #economicsfest
  26. Question: can tech increase productivity in health? @khcheck says new techs tends to increase demand too. #economicsfest
  27. Carol Propper thinks there is scope for significant tech-driven reorganisation. #economicsfest
  28. And she adds robots better at surgery than surgeons with a drink problem! #economicsfest
  29. Johnson: new tech might make more conditions treatable, so expand costs of healthcare, or might reduce costs of existing care. Net effect remains to be seen. #economicsfest
  30. Propper optimistic on AI in medicine. Robots can't lose sleep over problems at home; can't develop drink problem. #economicsfest
  31. “Robots are a lot better at surgery than people whose hands are shaking because they drink too much” - Prof Carol Propper at #economicsfest NHS debate
  32. Surprised no mention yet at #economicsfest of multiplier-effect benefits from NHS funding. We have NHS for good moral/political reasons, but there are economic arguments as well?
  33. NHS employs 1.2m people, government shouldn’t force same model on all of it, including how to contract out - Carol Propper #economicsfest
  34. GPs are technically private providers, although steeped in NHS culture points out @khcheck - & that enables rapid change #economicsfest
  35. Hard to integrate a means-tested and non-means tested system, says @khcheck on why health & social care can’t be integrated #economicsfest
  36. Even if we are approaching a cliff, NHS still vastly better than 20 years ago on any measure, says @PJTheEconomist #economicsfest
  37. Carol Propper reminds us what healthcare used to be like by referring to The Citadel by A J Cronin  #economicsfest