Can we afford to give our healthcare workers a pay rise?

With the NHS in the spotlight currently, performing magnificently well, I thought that it apt to look at whether it would be possible to give a pay rise to our healthcare workers. The government, who are responsible for the amount of money that the NHS can use, gives a large portion of their budget to healthcare (18%), second only to pensions (20%).

But the NHS doesn’t have enough money for what they need to do. If you divide up the NHS budget between the 243 million treatments that the NHS gives out each year, you end up with about £600 per treatment. This means that the NHS makes a loss every time that they treat someone that has fainted (cost: £620) or has asthma (£690), or someone that needs surgery on a broken leg (£5,120) or their baby delivered (£2,790). As you therefore might expect, they overspend on their budget, and this year, if things continue, they are expected to overspend by £30 billion.

But, I would argue that the NHS have a good system of cost-benefit analysis, called QALYs (quality adjusted life years). NICE’s (National Institute for Health and Care Excellence) definition of QALYs is a ‘measure of the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life’. It essentially assumes that health is a function of length of life and quality of life and combines these values into a single index number. A year of life lived in perfect health is worth 1 QALY. A year of life lived in a state of less than perfect health is worth less than 1 QALY. Death is assigned a value of 0 QALYs, and in some circumstances it is possible to have negative QALYs in extremely serious conditions. So, for example, a long but painful life might be equal in value to a short but happy life. It can therefore be used to weigh up the value of one treatment against another treatment. For example, a treatment with terrible side-effects will result in lower quality of life and therefore an overall lower QALY. The price of one QALY varies depending on your time of life and many other factors, but £50,000 is a generally accepted, approximate value. NICE also evaluates every drug for cost-effectiveness before it can be used as standard by the NHS. Therefore, as you can see, there are stringent cost-effectiveness rules that are in place, and one might say, why not lower the value of a QALY, but what if it were one of your loved ones that you were talking about?

These measures therefore save the NHS money, so why don’t they have enough? It could be attributed to the exploitation of technological advances, which are highly desirable in healthcare as they can improve a variety of aspects of the work of healthcare professionals, including: speeding up routine tasks, which currently doctors spend a lot of time doing; improving the accuracy of diagnosis (in radiography, for example, a study compared pneumonia diagnosis of 112,000 X-ray images comparing to success rate of an AI algorithm to that of 4 radiologists and found AI outperformed them); empower patients to monitor their own condition (with wearable technology and devices such as Docobo, which is able to be taken home, and records  vital signs such as pulse, blood pressure, oxygen saturations and many more); public health-based modelling on population data (such as models made for the current pandemic); can predict outcomes of disease and hence allow for the allocation of resources to be more effective. These are all incredible advances in healthcare, and can, will and already have had revolutionary impact in healthcare, but money is required to get them off the ground.

Another reason that healthcare costs are going up is because we are all living longer, increasing the number of old people around, and the older you are, the more likely you are to fall ill. The average 85-year-old man incurs healthcare costs that are seven times larger than an average man in his late 30s. As you can see from the graph, prescribing costs are increasing.

Furthermore, Britain is not a healthy nation, with three-fifths of Brits being overweight. Just under a third are ‘physically inactive’, meaning that they do less than two and a half hours of moderate exercise (e.g. brisk walking) a week. Moreover, many Brits consume excessive amounts of harmful products, such as sugar, alcohol, and tobacco.

We are also acquiring new drugs and treatments that are becoming increasingly expensive (some say the NHS bills are going up by 7 percent a year). Lots of people think that this is because pharmaceutical companies are greedily trying to inflate their profits, but this could also be because medicines are becoming harder to discover, as the ‘easily-discoverable’ ones have already been found.

The interesting thing about buying more expensive drugs is that, while there is evidence that the value of increased health care spending exceeds the cost, there is also evidence that many medical interventions provide little health benefit. To see this, we need look no further than the United States, who spend more per capita on health care than any other country, but many countries achieve comparable or better population health outcomes.

In conclusion, we cannot just give money to the NHS, as other sectors would then lose much needed money. Of course, if the government did change the budget, or increase taxes, and give more to the NHS, the cycle would continue, as a healthier population means more people live for longer, and more people need treating, driving costs up again. My solution would be putting a large investment in developing AI in healthcare now, that can then be sustainable in the future, and eventually begin to cut down on staffing, whilst maintaining the health standards of the country. This would allow the staff that end up working in healthcare to have a bigger salary, and although this doesn’t reward those in healthcare now for their fabulous work, this seems like the only solution. So no, with the NHS already overspending, I don’t think that it would be feasible to give them a pay rise.

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