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Transferability – The Solution to Systemic Bottlenecks in the NHS

by John Brian Shannon

Unfortunately for large healthcare providers like the UK’s highly rated National Health Service (NHS) people don’t always get sick near their local hospital. Rather, people will become ill, get injured, or encounter long-term illness everywhere throughout the United Kingdom regardless of where hospitals are located. Which is why some UK hospitals are full to overflowing while others have spare capacity.

One way to improve healthcare outcomes in the NHS is to incorporate transferability of treatment to relieve bottlenecks in the system.

Patients who can’t be treated in their local hospital due to lack of available capacity could be transferred to other hospitals in the UK where some amount of spare capacity exists and receive their treatment sooner than waiting for treatment at their local hospital. And even accounting for airline or rail tickets, possibly an overnight stay in a reasonably priced hotel in cases where the airline vs. operating room schedules don’t match, and for other incidental patient costs the health service would be required to pay, it would save the NHS money and dramatically improve healthcare outcomes for patients.

Patients who desire an upgraded hotel room could pay the difference themselves between the (covered by the NHS) standard room rate and the upgraded room rate.

When a patient has cancer, heart problems or other serious health issues, nothing is gained by making the patient wait for a treatment date in a hospital close to their home, because almost 100 per cent of the time those conditions will worsen as the patient waits for treatment.

Delayed treatment significantly increases treatment costs — because during the days, weeks or months of delay, the patient’s disease is certain to worsen.

Even those with slipped discs or other musculoskeletal impairments find their condition worsens over the amount of time their treatment is delayed. To say nothing about the suffering of the individual and their families while the person remains in a precarious health situation.

But if patients with serious conditions receive treatment sooner, healthcare outcomes for patients will improve and NHS statistics would improve because the disease or condition won’t have progressed as far in the case of faster treatment vs. waiting extra weeks or months for treatment at a local hospital.


Increase in Productivity

Workers who can’t work, can’t contribute much to GDP.

What is also true is that with faster treatment workers can return to work sooner and contribute to their company and by extension to the GDP of the United Kingdom.

Unhealthy people cost the economy, while healthy people contribute more. It’s therefore in the best interests of the government to get everyone the treatment they need with the minimum of delay.


Little Room for Improvement in the NHS

For an idea of just how highly the NHS is ranked in the world, please view the following chart courtesy of The Commonwealth Fund, an organization which ranks global healthcare systems via a number of metrics.

UK NHS and 10 other countries, Health Care System Performance Rankings

Health Care System Performance Rankings for the UK and 10 other countries. Image courtesy of The Commonwealth Fund.

It’s easy to see there is little room for improvement within the NHS, but Access (the ability to access treatment within a reasonable timeframe) and Health Care Outcomes (the success rate of treatment — which is often related to waiting times associated with treatment) could be significantly improved.


Scotland, Here I Come!

Some amount of transferability of treatment exists within the NHS at present, however, those in England tend to be treated or wait for treatment within England only. Scottish patients may be transferred to other hospitals in Scotland, and Welsh patients may be transferred to other hospitals in Wales. It’s likely a similar situation exists within Northern Ireland.

What would work to decrease bottlenecks in the NHS and thereby improve healthcare access and healthcare outcomes would be treatment transferability for patients throughout the entire United Kingdom.

Doctors could provide their patients with options for treatment when full transferability becomes the norm; (Example) “You can wait 6 weeks for treatment at your local hospital, or we can fly you to Scotland tomorrow, put you up in a reasonable hotel overnight and your operation will be scheduled for 7:00am the following day, and we’ll fly you home a day or two after the attending surgeon approves you for travel.”

For patients in severe musculoskeletal pain, or experiencing rapid cancer growth, or increasing difficulty in breathing or experiencing other serious symptoms, the sooner they can obtain treatment the happier and healthier they’re likely to be. That’s a win for patients, for doctors, for under-booked operating rooms in far-flung regions, for NHS statistics, and even for UK productivity stats and GDP.

There are so many ways to win with treatment transferability throughout the entire United Kingdom. It’s really the only systemic improvement left for the NHS.

Building more hospitals is expensive (and necessary in any case) but directing patients to underutilized hospitals (now, and even after more hospitals are built) can help patients towards sooner and better health while improving Access and Health Care Outcomes statistics for the NHS.

How to Fix Britain’s NHS

by John Brian Shannon

Britain’s National Health Service is famous for being two things: One of the highest rated healthcare services in the world, and for being chronically underfunded.

It isn’t about politics, Prime Ministers or technology — it’s about how costly it is these days to operate a modern healthcare system. Every Western country is grappling with the same issues, the UK isn’t extraordinary at all in this regard.

Here’s what one British Prime Minister said about the NHS

“One of the wonderful things about living in this country is that the moment you’re injured or fall ill — no matter who you are, where you are from or how much money you’ve got — you know that the NHS will look after you.” — former UK Prime Minister David Cameron

For all the griping that goes on about the NHS it continues to excel, turning in first-place performances in prestigious healthcare surveys.

Quite obviously the problem is funding a National Health Service that is tasked with caring for a growing and aging population.


How does the NHS stack up against other Western nation healthcare systems?

Britain tag | Commonwealth Fund National Healthcare Policy Survey 2013.

How does Britain compare against other Western healthcare systems? Image courtesy of the 2013 Commonwealth Fund International Health Policy Survey.


Five ways to improve Britain’s NHS

  1.  Lower healthcare costs by improving the environment
  2.  Lower healthcare costs via healthy activity programmes
  3.  Increase NHS revenue via public/private partnerships
  4.  Increase NHS revenue and lower demand on certain healthcare services
  5.  Augment NHS revenue via resident-payer healthcare premiums for those earning £25,000+ annually

Lower healthcare costs by improving the air we breathe

Of all the ways to lower NHS healthcare spending — improving the environment that Britons live in is easily the most cost-effective.

A highly regarded Harvard Medicine study informs us that coal-burning is responsible for up to $500 billion per year in additional healthcare, infrastructure and agricultural spending in the U.S. — so yes, up to half a trillion ‘externality’ dollars (annually) in America from burning coal alone. In the United States, coal accounts for 33% of America’s total electricity generation although coal-burning used to provide 70% of America’s primary energy demand.

In the UK, coal-fired power generation is also falling. In 2016 we saw wind power generation surpass coal-fired power generation for the first time. Coal provided 9.2% of the UK’s total electrical demand in 2016, but for decades it provided more than 50% of UK electrical demand. As coal-burning in the UK continues to be replaced by clean energy (wind power = 11.5% of total UK demand in 2016) respiratory and related ailment rates continue to fall.

It would be nice to think that leaving coal behind would lower NHS spending to an affordable amount. But that would be overly optimistic. Howevermuch Britain leads America in the race to leave coal behind, toxic air pollution from the thousands of diesel-powered lorries that pass through UK cities daily more than make up for it. In fact, air quality in London, Birmingham and Manchester is so bad that alarms are beginning to sound in many quarters.

Air Pollution in London Means 16,000 People Die Prematurely Every Year (Wired.com)

Some might underestimate the healthcare impacts of petrol and diesel-fueled vehicle pollution within cities. However, in 1974 it was common knowledge that an average of 80 people per day died in the city of Los Angeles alone as a result of air pollution from cars and transport vehicles during so-called ‘smog days’. People were dying on the sidewalk as they waited for the Ambulance to arrive.

Fortunately, California implemented the first of many clean air laws and soon set the global standard for cars and truck emissions. And it has been a stunning success! With a population more than double since 1974, daily premature deaths due to air pollution in Los Angeles are practically unknown in 2017. And the L.A. economy continues to grow — no longer held back by an ailing population (who didn’t realize they were ‘that’ ailing until the new clean air standards kicked in) and everyone began to feel much better, and consequently found themselves outdoors and enjoying the fresh air more often.

Due to topography and weather patterns in London, smog is a serious problem and has a measurable effect on the NHS budget. Manchester isn’t any better, nor is Bristol. Therefore, the UK must pass clean air legislation that exceeds even L.A.’s stringent air quality regulations.

And the easiest way to do that is to lower coal-fired burning to a maximum of 5% of total UK electrical demand and ban diesel lorries from any city with more than one million residents. With the existing technology in hand these aren’t difficult targets.

Many trucks (lorries) in the United States are now converting to compressed natural gas (CNG) in an effort to meet modern air quality standards. The trucks continue to run on diesel fuel, but CNG is injected into the engine any time the vehicle in under load (climbing a hill, getting up to speed, etc) and during times of city travel the vehicle can run on CNG exclusively which emits zero pollutants and zero particulate matter. CNG-burning produces carbon dioxide and water vapour only (neither is toxic) with a small penalty in overall power output. And such engines last longer than diesel-only engines.


Lower healthcare costs via healthy activity programmes

In Canada, former Prime Minister Pierre Eliot Trudeau passed legislation on a novel programme called ParticipACTION. It was a programme designed to get people walking, moving, exercising and it created awareness among citizens — that activity, especially outdoor activity, was a prerequisite for good health and long life.

It was a popular government programme complete with kooky TV adverts that compelled an entire generation to get up off the couch and exercise. Government officials from all provinces handed out placards and Participaction lapel buttons, and flags with the Participaction logo emblazoned on them. If you couldn’t make it from your comfortable television viewing position out to the street in one minute — no cheap Participaction prize for you! And your neighbours thenceforth suspected you were somewhat less than a loyal Canadian on account of it.

Participaction ended after years of success with many studies attributing Canadians good health to the Participaction programme. It produced measurable results and the politicians loved meeting citizens and giving them tacky Participaction merchandise in completely random and impromptu settings.

Long after the programme ended, then-Prime Minister Stephen Harper restarted the Participaction programme and it continues to save all levels of government in Canada billions of healthcare dollars annually.

All it took was simple legislation, some committed politicians from all levels of government, catchy TV adverts and tacky Participaction merchandise, to save billions of dollars in healthcare spending per year! Who’da thunk it?


Increase NHS revenue via public / private partnerships

Many businesses are excellent corporate citizens, they just need to be asked.

In many cases, corporations will fund a new construction (say, a new wing of a Hospital) in exchange for their corporate logo appearing prominently on the building, in the building lobby, or etched in concrete among the property landscaping. Sometimes it’s a tax write-off for a corporation involved in the construction of the project, sometimes it’s a corporation donating funding in lieu of paying tax on their profits. Either way, large corporations can become part of the solution. It doesn’t hurt to ask corporations how to make that happen more often (Perhaps a minor tax change?) You never know until you ask.

In a time of obscene excess liquidity (multi-billions sitting in banks, doing nothing productive for the economy) a minor tax adjustment could trigger billions of pounds sterling to hit the NHS budget allowing it to add entire new wings to existing Hospitals, adding new technologies to Emergency Room facilities, or it could be used to purchase more Ambulances and train more Paramedics.

A minor corporate tax change could free-up billions of pounds in sponsorship funding for NHS facilities.


Increase NHS revenue and lower demand on certain healthcare services

Way back in the 1990’s, Ralph Klein, then-Premier of the Canadian province of Alberta, decided to allow private (for profit) MRI clinics.

Due to long wait times to get an Alberta government MRI scan in Alberta it was thought that private companies might take the risk, invest in the expensive and relatively new technology, and open MRI clinics for walk-in clients.

It was expected that Alberta doctors would discuss with their patients the expected wait time for a government provided MRI (long wait, but no cost to the patient) vs. a private MRI clinic (an $800. fee, and typically a 1 hour wait) and it was the patient’s choice where they would get their scan.

The liberal media went into a frenzy. Asking people to PAY for an MRI? Outrageous! And, anyhow, no one in their right mind would pay for an MRI, when the government-funded MRI’s were available at no cost to the patient!

It was such a bad idea that it’s now the de facto state of affairs in Canada.

In the final analysis, what the private MRI clinics did more than anything was to dramatically reduce the wait times at government MRI locations.

Thousands of relatively wealthy citizens decided to pay out-of-pocket to access the results of their MRI scan more quickly. Which, until you’ve actually had cancer or some other serious ailment or injury, seems quite illogical. But waiting months to find out ‘how bad it really is’ just isn’t what patients prefer. Imagine that!

Not only did private MRI clinics lower wait times for relatively wealthy Albertans, the clinics also lowered wait times for patients waiting in the government-funded MRI lineup — consequently, many seriously ill people were able to receive their treatment sooner and at much lower cost to the government healthcare system in the case of progressive diseases, due to sooner diagnostic access.

The end of this story is that private MRI clinics saved Alberta Healthcare so much money, the Premier of Alberta later ordered that anyone who had paid for their own MRI at a private clinic, be partially reimbursed by Alberta Healthcare. Instead of an $800. bill for the patient, it became a $200. bill or even less, depending upon the exact MRI procedure.

In Canada, it’s no longer MRI clinics only that function as private (for-profit) clinics. Many procedures or treatments can be arranged more quickly at the patient’s option, at a private medical facility.


Augment NHS revenue via resident-payer healthcare premiums for those earning £25,000+ annually

The by far simplest and easiest way to increase NHS revenue is to charge each UK resident £20 each month for an NHS healthcare premium, and operate it like any other insurance plan (car insurance, home insurance, etc.) and provide a discount for those who pay in advance, instead of monthly. (‘Resident’ in this case, means all UK citizens, expats, foreign students, and anyone else living in the country longer than one month)

Not only that, but this additional premium (‘additional’ for those that already pay NHS premiums) could be deducted via automatic payroll deductions, while some banks might offer mortgages with NHS premiums built right into the loan, as they sometimes do with life insurance.

Assuming that 40 million UK residents earn over £25,000 annually, the total yearly revenue added to the NHS would be in the range of £9 billion annually!

Which would cover the NHS’s £450 million annual shortfall nicely, wouldn’t it?

Instead of ‘just getting by’ on the national healthcare front, Britain could build one new Hospital per year, fill them with even more of the world’s best medical professionals, and add free dental work up to £200 per year to the many benefits of Britain’s National Health Service.

That’s what I call a sustainable NHS budget plan.


But imagine if all of the above suggestions — #1 through #5 — were implemented throughout the UK. Not only would NHS budget deficits disappear, stable and long-term funding would become the norm, and the result would be better healthcare and shorter wait times for everyone.


Bonus Graphic

Britain Statistic: Share of GDP expenditure on theBritain National Health Service (NHS) and adult social care in the United Kingdom from 2015/16 to 2030/31* | Statista

Britain National Health Service: Share of GDP expenditure on the National Health Service (NHS) and adult social care in the United Kingdom from 2015/16 to 2030/31* | Statista

Find more statistics at Statista