No More Games - the NHS Mythbuster

Mar 3, 2015
4 min read

Everyone has an opinion about the NHS, but how many of us actually check the facts to support our views? At the BMA, we want to make sure the debate about the NHS is fair, balanced and supported by evidence. We’ve chosen some of the most common myths about the NHS to show how things aren’t always as reported.

Myth: The NHS is performing badly compared to health systems in other countries

In 2014, a panel of experts from the Commonwealth Fund, a respected Washington-based foundation, published a report1 comparing the health systems of 11 leading nations.

The NHS came first overall, scoring highest on quality, access and efficiency. To quote the report: “The UK continues to demonstrate strong performance and ranked first overall.”

The report measured standards of care across 11 categories and the NHS came top in eight of them, ahead of the health systems of countries such as Sweden, Switzerland, Germany and the US.

There are, of course, many measures for assessing how well a health system is performing, but the Commonwealth Fund report does present a very different perspective to the daily stories about declining standards in the NHS.

Myth: The NHS is no longer affordable

Critics of the NHS describe it as no longer affordable in the modern era – that it’s an anachronism designed to serve post-war Britain. Yet, this view is certainly not supported by the King’s Fund2. A study by their chief economist, John Appleby, suggests that the NHS is affordable if the political will exists to fund it properly – and that this is essentially a political choice that should be informed by public debate.

It is worth looking at the value for money which the NHS currently provides. Despite having to cope with increasingly complex demographic and public health challenges, the NHS continues to deliver a highly efficient service. The Commonwealth Fund ranked the UK first for efficiency out of the 11 national health systems it compared, recognising the NHS’s ability to “maximise the quality of care and outcomes given the resources committed”. These findings were based in part on an annual cost per head of just £2,008 in the UK, less than half of the £5,017 spent in the US.

Myth: The private sector is always more efficient in delivering healthcare

Since the 1980s, successive governments have introduced the private sector into different areas of the NHS. The BMA has always been clear in its belief that a publicly-provided and publicly-funded health service delivers the best care for patients.

One problem with private sector firms, some of which are part of large multi-national corporations providing care for patients, is that they can cherry pick those parts of the health service which are easier to deliver. When they find that they can’t make a profit for their shareholders, they can and do walk away from contracts, leaving the NHS to pick up the pieces, often at the expense of the most vulnerable patients with the greatest need. This destabilises and fragments the NHS, making it even more difficult to ensure a co-ordinated and integrated health and social care system.

The NHS is facing mounting challenges with an ageing population, often living with a number of chronic, long-term conditions. A publicly-provided and publicly-funded system is able to put patient needs first and prioritise long-term standards of care.

We believe that the health and wellbeing of patients must always come before making profits from healthcare.

Myth: Winter pressures on A&E are the fault of GP services

There’s been intense pressure on many Accident and Emergency (A&E) departments across the UK this winter, with the NHS often being unable to meet the target of seeing, treating, admitting or discharging 95 per cent of patients in under four hours. Some have suggested the main cause is patients’ inability to see a GP when they want to.

However, the King’s Fund has questioned this3, arguing that 85.4 per cent of patients are able to get a convenient appointment, and that of those who can’t, only 9.8 per cent reported going to A&E or a walk-in centre.

Instead, The King’s Fund has identified staffing in A&E departments as a root cause of the pressures, with only 50 per cent of specialist emergency medicine training posts currently being filled. Demands on the A&E system have also resulted in many trainee doctors not choosing to specialise in emergency medicine due to the long, unsociable hours and intense working conditions. Other issues also exacerbate this pressure, including the disruption caused to the flow of patients through A&E by there being fewer hospital beds overall. Problems with access to community, mental health and social care services mean that it is often difficult to discharge patients promptly, adding, in turn, to the pressure on beds.

While mounting pressures on GPs clearly do have some knock on effect on A&E, the evidence does not suggest that this is a major cause.

Myth: Health tourism is bankrupting the NHS

Health tourists, that is, people who come to the UK with the sole purpose of receiving free medical treatment, are often quoted as being a huge drain on NHS resources. While some quote a cost of £200 million to the taxpayer and others speculate that this could run to billions, there is little evidence to support these views. Full Fact4, for example, estimates the figure to be closer to £45 million, equivalent to 0.15 per cent of the NHS budget of £104 billion.

Recent research suggests that people coming from overseas to receive healthcare in the UK actually provide valuable revenue for the NHS. A study by the London School of Hygiene and Tropical Medicine and University of York5 shows that in 2010-11,18 NHS trusts made £43 million in combined income from overseas visitors paying for their treatment. In this 12 month period, 52,000 people who entered the UK declared that seeking healthcare was the primary reason for their visit. By contrast, the Government’s latest research estimates that the number of people coming to the UK for free healthcare is currently between 5,000-20,000 per year. By this measure, the number paying for treatment is more than double that receiving it free, meaning that the NHS is very likely to be making a net profit from treating non-UK patients.