The Call to “Protect Our NHS”

In light of recent events, I’ve been thinking a lot more about how we arrived at the current situation. I don’t believe anyone truly has the answers yet so here are a few questions to ask instead. There will be a few posts coming covering certain questions to inspire you to not only think about the world but also to go out, try to understand it and dig deeper than the first answer.

We have all now seen the effects that the current pandemic has had on the world. The topic for this is post is to highlight the reduction in funding for the NHS and why the people are being asked to save it.

Is it right to ask the retired and civilians to help the NHS?

Before raising points for this question it is probably right to start with some facts from Fullfact.org (an independent fact check charity), IFS.org.uk (Institute for Fiscal Studies) and ONS.gov.uk (Office for National Statistics). After the 2008 housing bubble the economy was in a bad state and government borrowing skyrocketed in order to bail out a lot of the banks that were on the verge of collapse. Due to this collapse government borrowing rose to 10% of GDP (Gross Domestic Product). GDP in this case is measured as the total of; Household spending + Government spending + investment + net exports. Household spending making up around two thirds of this. Since then the austerity period has reduced this to less than 3% of GDP in 2016 but has continued to drop as the austerity period was extended. Austerity being the rate of day to day government spending for public services.

The above chart from Fullfacts.org shows some data on the spending on health over the years. The lines represent the government parties average growth. One thing to note is that this a growth chart and therefore spending is naturally higher every year than the previous. This is often a proud statement mentioned by MPs however, this is no surprise. Even a 0.1% increase per year would be the most ever spent (only 3 years have shown negative growth since 1979) so to really understand this you need to look at the demand and population increases.

Another thing to note is that public health spending from 2009-2016 is the lowest on record in the UK and averaging at a 1.3% per year increase. When including previous years; for 1955-2016 the average jumps up to 4.1% increase per year (Source: UK health spending BN201 by IFS). If you consider an ageing population, which is estimated to be 1 in 4 people over 65 by 2050, then this spending gets hit even harder as the spending increases massively for older people.

Source: Office for national statistics

Looking at the above graph for population up to 2018 you can see the large rise in population from early 2000’s. In 2000 the estimated population was 58,886,100 and in 2018 this rose to 66,435,600. Between 2009 and 2018 this was an increase of 4,175,100 people in the UK. When you consider the below table showing age distribution this becomes an increasing problem.

As stated before the older a population gets the more spending is required to account for the increase in costs to the NHS. Also note that although the increase in over 65s seems like a small percentage (2.1% increase from 2006-2016) the population increased as well. So this is a bigger percentage of an even bigger population and it is predicted to get much worse. The graph below (Source: UK health spending BN201 by IFS) shows this impact of cost cutting on the department of health’s budget. When you look at the cost per capita is it even and stable with population however, when you include age as a factor you can see the decline in funding.

Source: UK health spending BN201 by IFS

It unfortunately doesn’t get much better when you look at the staffing of the NHS. The graph below shows the amount of staff in NHS hospitals per month over an 8 year period. When you calculate the numbers, over this 8 year period, it roughly comes to around a 1% increase in staff in 8 years despite an additional 4,175,100 people in the UK and an estimated 2% increase in over 65s. A lot of this is due to almost the same amount of people joining the profession as there are leaving each year. Facts which have been reported by the NHS digital. Why so many people leave the NHS I will leave for a separate post.

Source: NHS workforce statistics – December 2018

To circle back to the initial question; Is it right to ask the retired and civilians to help the NHS? If you take into consideration the above nothing that has happened in recent events should be a surprise. The NHS has been driven down to the bare minimum it can run on day to day (see my previous post on efficiency!) and is now in a worse situation seen since before the financial crash of 2008 and austerity cut backs were put in place. The funding that is currently supplied to the NHS and the poor response of the government to the pandemic is being criticised by governments and countries across the globe.

Personally, I believe it seems unfair to ask the most of those who are victims of these problems. The nurses asked to work without the full equipment they need to fight these issues; the retired who are being asked to come back to work where they are at higher risk; the younger working and middle classes who are being asked to put their lives on hold and risking losing jobs as companies collapse due to the lockdowns (which could have easily been prevented or reduced if mass testing was introduced early enough) and tax payers donating money to the NHS from their own pockets.

I hope you have found some of this interesting and it has questions you haven’t thought of or maybe inspired you to think of your own questions. So I will leave you with one final one.

Do you think this will create a reform of the economy and spending policies or will it be ignored and carry on as before?

Stay tuned for the next post and sound off in the comments what you think!

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Efficiency Across the Board

In light of recent events, I’ve been thinking a lot more about how we arrived at the current situation. I don’t believe anyone truly has the answers yet so here are a few questions to ask instead. There will be a few posts coming covering certain questions to inspire you to not only think about the world but also to go out, try to understand it and dig deeper than the first answer.

We have all now seen the effects that the current pandemic has had on the world. The topic for this is efficiency and how it has lead to a complacency in every country.

Are We Too Efficient?

The current state of the world is an unusual one and one that many have not have seen in their lifetimes. Supermarkets running out of stock and having bare shelves; ventilators being in short supply; personal protection equipment that can’t meet demand; NHS staff being brought out of retirement to fill gaps in hospitals and a national call for assistance asking us to “help protect the NHS” (which I will cover in a separate post). Why did supermarkets, medical equipment and PPE providers / manufacturers run out of stock. I believe the answer lies in efficiency.

The current global market almost entirely relies on “just in time” manufacturing / delivery and lean processes. This effectively means the minimum amount of stock is held at any one time and is only produced and delivered when the demand is required. Looking back at my previous post “The Cost of Panic Buying” this just in time marketing plays a large part. As I mentioned, the more likely factor of a lot of people shopping more regularly and picking up a few extra items each time is more likely the issue. This is where “just in time” process comes into play. A rapid change in demand across all items from a large population can really change supply lines. If unprepared for such an emergency it is easy to see why shelves are empty and governments, globally, are pushing for ventilators. When systems are running at 95% capacity it doesn’t leave much headroom for error. Tiny changes in shopping habits result in a huge impact as 95% capacity becomes 105% as an example.

However, you might be thinking if they can see or predict an increase in demand why can’t they just change their order to bring in more stock within a few weeks. Enter “lean process”. Lean process is, fundamentally, similar to efficiency and describes the minimum amount of people (a resource) in order to produce a result (in this case products and services). For perishable items such as food or PPE masks (which do have expiry dates) this makes sense to minimise waste and stock counts in order to save money. The limiting factor here is the people. Without the right quantity of people the amount of raw materials is meaningless. This type of business works great in the good times but falls apart rapidly in the bad. In some cases Brexit may have helped in as large medical suppliers began stockpiling goods in the UK, at a cost, in order to protect against worst case trade deals. Depending on the capacity margin this can cause the problems that we have seen over the last few months of different severity. As soon as demand spikes even if there are enough resources to produce the required products there is often a lack of people available in order to produce the final products in time.

As all the products are still available the issue of capacity never seems to be a problem. We all assume we will have enough and this leads to complacency that these safety nets can be scrapped without consequence.

I hope you have found some of this interesting and it has questions you haven’t thought of or maybe inspired you to think of your own questions. So I will leave you with one final one.

Should we reduce efficiency if it means the impact in difficult times can be reduced? Perhaps holding emergency stock that can be sold and replaced before the expiration date is something we can take away from this crisis.

Stay tuned for the next post and sound off in the comments what you think!