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 sectors of the UK economy that could use that amount 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 developed in recent years.

Many NHS hospitals face energy bills of more than £1 million per month because they’re old buildings and were never 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.

Here’s the arithmetic: 1600 x (£1,000,000. x 12 months) = £‭19,200,000,000.

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. 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 earns the NHS only adds 5% to their revenues in year-5 of this proposal, that’s still 5% more funding than the NHS presently receives from the UK government.

Therefore, a massive new hospital spending programme is a sensible way to improve the NHS budget picture and help them fund the purchase of expensive diagnostic and other medical equipment. Not to mention better healthcare outcomes for Britons and 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 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.

Have a great week, everyone!