Re: Helen Salisbury: The NHS is not unsustainable

Dear Editor
In “The NHS is not unsustainable” [1], Dr Helen Salisbury asks whether we have “Too much healthcare in the UK? Too Little? Or just the right amount?”. She asserted that “Most people would agree that the country would benefit from more doctors and nurses, shorter waiting lists…”

This is not a question that can be answered. To illustrate this, let us exchange healthcare for something else: Do we have enough supermarkets, too many or too few? How about garages? Golf clubs? Restaurants? Coffee shops?

“Enough” means supply meeting demand, but that demand is not just desire. The demand for Italian sports cars for example is not how many people would want them if money was not a consideration.

Let us consider if we had a National Food Service with an aim of equality of access to the best food in the world irrespective of means. No doubt most people would agree that we would benefit from more Michelin starred restaurants. How would we know how many we ‘should’ have?

In the same way we cannot know how much we ‘should’ spend on healthcare, as the British people do not freely make that choice. They do not decide between buying an extra unit of healthcare or better food, or a warmer house.

Dr Salisbury incidentally quoted old figures for healthcare spending, 9.9% GDP in 2019. For 2022 they are almost 12%, 5th in the world and within 1% of the 2nd. Not including COVID funding which took the budget up to £200B. The budget for this year is over £180B, which is 50% more in real terms than 2009![2]

Dr Salisbury concluded her article by asking “What do you think we should prioritise for spending, above health?” This is an easy question. The fundamental role of government is to protect its citizens from physical force. In a country where violent crime is rising, where waiting lists for court cases are at an all time high, and where international dangers are the highest in a generation, the priority for funding is Police, Armed forces, and the Criminal Justice System.

The NHS is indeed unsustainable. Its budget has required real terms increases of 4% annually since being founded just to stand still. I would therefore reverse the question to Dr Salisbury, and ask her what other functions of government should reduced in order to prop up the NHS?

References:
1. Salisbury H. The NHS is not unsustainable. BMJ 2023; 381:991.
2. https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget