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What the NHS Could and Should Be in a Post-Brexit World

by John Brian Shannon

One of the great things about a post-Brexit Britain is that almost everything in the UK can begin anew, with a clean sheet as it were, and number one on that list should be the country’s excellent National Health Service (NHS).

At present, the UK contributes £12 billion more to the annual EU budget than it receives, and that’s a nice round number to spend on the NHS once Brexit occurs. Although there are certainly other worthy sectors of the UK economy that could use that level of funding.

But, for now, let’s concentrate on what the post-Brexit world could (and should) mean for Britain’s NHS.

And since we’re starting with a clean sheet, let’s not be limited by our present thinking and instead focus on how the NHS could provide better healthcare to Britons, and how the NHS could better serve the UK.


How to Maximize the NHS

The NHS should be required by UK legislation to begin operating at a 10% profit within 10-years of Brexit

How can the NHS operate at a profit when it can’t even hit break-even now, you ask?

Simple.

Secret Ingredient #1 – Cost savings through energy efficiency

At present, the NHS operates a large number of old hospitals, which at the time they were built were probably considered world-class hospital and administration buildings. But I guarantee that none were built to the LEED Gold nor the LEED Silver energy efficiency standard — let alone the net-zero energy usage standard called LEED Platinum as those standards were only recently developed.

Many NHS hospitals face energy bills of more than £1 million per month because they’re old buildings and aren’t worth the cost of renovating them to LEED energy efficiency standards.

As there are over 1600 NHS hospitals, clinics, and administration buildings (but nobody knows for certain because there’s so much overlap and duplication) and if each of those buildings are costing an average of £1 million per month to heat, light, and air-condition, that totals £‭19,200,000,000‬ annually.

So, £‭19 billion is going straight out the window every year in wasted energy. And let’s pretend there’s another £‭1 billion in other inefficiencies in these older, no longer fit for purpose hospitals, for a grand total of £‭20 billion worth of wasted NHS funding annually.

That’s a lot of wasted money.

However, the NHS has never been asked to turn a profit, and therefore, didn’t have the money to build newer, more fit for purpose buildings over the decades — or to throw good money after bad trying to turn old, unfit for purpose buildings into LEED Certified energy efficient buildings that require zero (net) energy from the grid.

Indeed, some buildings in the United States contribute more energy to the grid than they consume due to their LEED Platinum certification, which results in a net zero energy cost annually, and such buildings can provide a tidy return on investment each February 1 when the utility companies are obligated by law (California) to settle-up with minor power producers connected to the grid. Granted, there’s a lot more sunshine in California and making it easier for a building to produce more power than it uses over the course of a year.

But UK wind turbines add power to the grid all year (particularly in autumn, winter and spring) and as for solar power in the UK, the solar insolation value (the amount of sun that falls on one square metre) is dramatically higher during the summer in the UK.

So, on the one hand, we have a cash-strapped NHS that can’t afford new buildings that would allow them to save £‭20 billion in wasted energy per year, nor can they afford to refit their existing buildings to make them energy efficient because that’s even more expensive than building new, energy compliant hospitals and administration buildings.

Should the UK continue to throw good money after bad in the NHS, or should the government use taxpayer money to turn the NHS into a profit-making venture?

The answer… couldn’t be clearer.


So Far, We’ve Talked About Saving £20 Billion Annually; But How Can the NHS Earn 10% Profit Annually?

Almost every developed country in the world has a universal healthcare system that charges their citizens a monthly healthcare insurance premium.

In Canada, that premium tends to be $65.00 – $100.00 per month/per adult — although some provinces in Canada pay the monthly premiums for their residents out of general (tax) revenue.

Here’s the monthly healthcare insurance premiums in the province of British Columbia, Canada:

BC monthly healthcare insurance premium chart 2018

BC monthly healthcare insurance premium chart 2018. Image courtesy of the British Columbia Medical Services Plan. Click the image to visit their website.

Yet, as reasonable as those premiums are, the full cost of care is covered by the Medical Services Plan (MSP) whether those injuries/sudden onset disease/chronic disease or other maladies befall the patient while in British Columbia or anywhere else in Canada — or while travelling abroad.

Further, whenever wait times for patient care become extended within the BC (MSP) system, British Columbia’s Medical Services Plan authorizes Doctors and Surgeons to outsource patient treatment to Canada’s other provincial healthcare systems, or patients may be sent for treatment to the United States where MSP pays the full cost of treatment — even if said treatment costs more in the U.S. than it would in British Columbia.

Which is a typical model that developed nation healthcare systems follow.

Secret Ingredient #2 – Accepting Foreign Patients to Add Revenue to the NHS

Some developing nations also follow this model with their national healthcare systems (outsourcing and paying for medically necessary procedures they can’t perform in their own country, or when they can’t perform necessary procedures in a reasonable timeframe due to scheduling issues) and private insurers often shop for a better rate or timeframe for insured persons so that the patient receives expert and more timely care — which creates better healthcare outcomes for their clients.

So, why wouldn’t the UK government fund dozens of brand-new, state of the art, energy efficient NHS hospitals specially designed with additional capacity to accept planeloads of patients sent to the UK by foreign healthcare providers?

In that way, over time — and let’s be realistic, this is a 10-year programme to capture every possible foreign healthcare opportunity and payment from overseas healthcare systems — the NHS could begin to show a profit, thereby helping to subsidize the astonishingly high cost of providing healthcare services to Britons.

Even if accepting foreign patients subsidizes the NHS budget by only 5% in year-5 of this proposal, that’s still 5% more funding than the NHS presently receives.

Therefore, a massive new hospital spending programme is a sensible way to improve on the already high standards of the NHS and improve the healthcare that Britons receive. Not to mention better healthcare outcomes for Commonwealth nation citizens who will travel to the UK to receive treatment paid-for by their respective healthcare insurer, whether private or public.

Let’s hope that British politicians are wise enough to see the value of such a proposition and that they’re larger than life — because that’s what it’s going to take to get the job done.

In previous generations British politicians were up to the challenges of their time; Wouldn’t it be great if this generation of UK politicians were up to the challenges of our time?

UK and 10 other countries, Health Care System Performance Rankings

UK and 10 other countries, Health Care System Performance Rankings 2018. International Health Policy Center. Image courtesy of the Commonwealth Fund.

The above chart demonstrates why foreign countries could and should send their overflow patients to the NHS… as every year since rankings began, the NHS has scored either #1 or #2 in the annual Commonwealth Healthcare Performance Rankings.


Next week, we’ll talk about doing a similar thing with the UK education system.

Have a great week, everyone!

Getting Brexit Done Will Allow the UK to Get onto ‘the Good Stuff’

by John Brian Shannon

‘What Could be Better than Brexit?’ You Ask

Once Brexit is completed, the UK will be perfectly positioned to sign free trade deals with every country in the world. Indeed, some countries are eagerly anticipating signing free trade agreements with the United Kingdom post-Brexit.

Here in Canada, free trade with Britain is viewed as nothing more than the natural and obvious progression in our centuries-old relationship, and Australia, New Zealand, Singapore and India see free trade with the UK as a true Win-Win situation where all sides benefit from membership in that free trading relationship.

But in the UK for some inexplicable reason, free trade with Commonwealth nations is seen as a long-shot, something Britons would like to have but feel is almost impossible, and some seem to think the UK is ‘unworthy’ of such treatment by other Commonwealth countries and their 2.3 billion citizens.

‘The British really need to get out more, and see the world for what it is instead of seeing it through the prism of an imperial guilt trip’ seems to be the prevailing wisdom in the former colonies.

Get out there, UK! And, welcome to the 21st-century. We need to trade with you.


The Post-Brexit Domestic Agenda

Once freedom is established across the land, the UK government can rightly turn its attention to how citizens are faring. Spending on the NHS, education, housing, the manufacturing sector, agriculture and transportation networks can be improved from the present (underfunded) model.

How? Easy!

Presently, UK taxpayers dutifully send their money off to the government, which then sends a substantial portion of it on to Brussels. And every month, UK taxpayers send £1 billion more than they receive back from the EU. Which, as you’ve guessed, means that UK taxpayers send £12 billion more annually to the EU than they receive in return.

With an extra £12 billion a year to spend on the NHS post-Brexit — that’s £230 million a week — the NHS would eventually recover from being cash-starved since 2010 or thereabout.

But if the government elected to spend that £12 billion per year on education — British students would be in for a world-class education where no student gets left behind and every one of them would receive a tuition-free PhD-level education or tuition-free trade-certificate education — just as many European and some South American countries already offer. What a great leg-up for the country! Every British student turns into a highly-educated intellectual or tradesperson with the relevant documentation to prove their dedication to their profession or trade.

Or, if the government decided to solve the UK housing crisis by building tens-of-thousands of low-income homes for Britons. Which (housing crisis) is in the process of being solved anyway, as thousands of EU citizens return to the continent prior to the final Brexit date — thereby freeing-up housing in the UK market — whether rental or purchased.


And similar applies to other sectors of the UK economy. Once Brexit finally happens, the UK will have an extra £12 billion to spend annually. How the UK government chooses to spend it, is down to the priorities of the post-election government.

One thing is for certain, leaving the EU will allow an extra £12 billion to be spent every year in the UK economy. Which means that ONE major problem can be solved per year (NHS, education, housing, manufacturing, agriculture, transportation networks, high taxation) but not ALL major problems at once!


The Piecemeal Approach is the Wrong Approach!

To my mind, dropping a few billion here and there throughout the economy in an attempt to please everyone… definitely ISN’T the way to proceed.

With an extra £12 billion, the next government should decide which problem to solve in year-1 (£12 billion) then, in year-2, another major problem can be nailed-down to a satisfying conclusion (the second £12 billion spend), and in the 3rd-year something else can be solved once and for all time with the third £12 billion spend.

Typically, democratic governments seek to please the largest number of voters by dispersing such economic windfalls (a £12 billion annual windfall in this case) relatively evenly throughout the economy. But in the UK, each major problem in the country could be permanently solved via a single-year £12 billion spend in each problem area.

And that should galvanize British minds into prioritizing the next 5-year spending round.


How Would YOU Spend It?

Maybe you’re an overworked healthcare worker. We know how you’d spend the money. And we don’t blame you. Thank you again! for all the great work you do saving lives and dramatically improving the lives of the sick and elderly with your fulsome commitment. We salute you!

Or, maybe you’re a social worker who sees lives being wasted because there aren’t enough entry-level jobs, or safe housing, or supports in place to help the young, the elderly, the infirm, or the marginalized, to help them progress out of their poverty-based existence. In such cases, even relatively small amounts of money can make a huge difference in their lives — lifting them out of poverty and into work in a matter of weeks.

Every country needs more taxpayers and lifting people from UC to employment results in a double benefit for the economy — instead of the government paying such people to basically stay alive until they’re needed in the workforce, those people will then begin to pay into the tax revenue stream. Entire towns and boroughs could be revolutionized by the addition of a relatively inexpensive 1-year spending programme to the mix.


Brexit Can Work for Farmers!

Maybe you’re a farmer/rancher worrying about your EU subsidies going away. (And they will) Of course it would be great if the UK government decided to pay you the same subsidies that you enjoyed when the UK was a member of the EU.

But even better solutions await.

Why grow a crop that doesn’t earn any money? Why continue to stay in the dairy business competing with the heavily-subsidized EU, U.S., and Canadian dairy industries? Maybe it’s time to switch gears and raise animals or grow crops that don’t need subsidies.

Or, maybe it’s time for you to rent your land to the utility companies for the installation of wind turbines for £4000. per year/per turbine? In that way, you’re earning income instead of waiting for government subsidies to suddenly fall, as we’ve seen over the decades.

In the case of wind turbine installations, most of your land remains available to you, it’s just that you lose the footprint of the turbine tower and the utility company needs a gravel access laneway to each turbine which translates to an average loss of 1-acre of land per turbine for the farmer.

Some land is too rocky to grow crops/graze cattle anyway, so that isn’t much of a loss in some cases. Certainly, receiving £4000. per year/per acre from a utility company in land lease fees beats all the work that goes into growing crops, only to gain £800. to £1200. per acre annually! And, as for grazing cattle or sheep on marginal land, an acre of that land might only be worth £60. to £100. annually to your farm. Or less.

Yes, you can tell that I love farmers and ranchers because I’ve devoted all this space to them. But it illustrates how Britons and the government need to think differently in the post-Brexit world.

Instead of competing against highly-subsidized countries (and bigger countries will always win as they have more taxpayers to pay those high subsidies) it’s time to change gears and switch towards a more sustainable and more profitable economic model.

Grow those high-demand/no-subsidy crops! Raise those animals that don’t require subsidies! Rent your less-productive farmland to utility companies for more profitable wind turbine or solar panel installations — where your profits aren’t decided in a closed-door backroom in the EU, America, or Canada.


Britons: Compete on Your Strengths, Not on Your Weaknesses!

In short, dear Britons, compete on your strengths and cease competing on your weaknesses against much larger and more highly-subsidized blocs. The degree to which you can succeed in that is the degree to which you, your family, and the UK itself, will prosper.

And in case I didn’t make it clear enough, above;

In a post-Brexit UK economy, innovation ruled by merit-based thinking is the best way for individual Britons, British families, and the UK to succeed.