No Such thing as a free meal – thinking about the future funding of the NHS

Last Friday, the only commitment to be found in my diary was a breakfast meeting with a colleague in Manchester. The meeting was a very good one, the breakfast, however, a slightly strange one. I ordered the vegetarian option, thinking Linda McCartney sausages, eggs, mushrooms, tomatoes and so on. What I got was very different! Two small slices of artisan bread, one smothered in tomato hummus, the other covered in something called squashed avocado, two poached eggs, a grilled mushroom, and three spinach leaves. When the bill came It was clear that I needed to take out a mortgage to pay for it. Fortunately my colleague and friend picked up the bill, although he did say it was because I’m a pensioner now! Thank you Brian.

It was an experience that I imagine Shahid Khan doesn’t have very often.  Forbes estimated that Khan’s net worth, some $8.7 billion, ranked him 158th in the world in 2017. Khan is a Pakistani-American billionaire who made his fortune from designing and selling car bumpers. He was in the news last week because of his offer to buy Wembley Stadium for £900 million. If the deal goes through, the Football Association are said to want to use the money to revitalise the grass roots game and provide hundreds of new 3 and 4G pitches. I don’t follow football at all and have never had any interest in it whatsoever. I guess the new Wembley Stadium has lost some of its iconic standing so selling it not likely to hurt the UK psyche. 

What I was surprised about was the contrast between this story and another one last week about so called ‘payday loans’.  Some 300,000 people a month take out one of these high cost, short term loans. At the start of 2017, 1.6 million people had a payday loan debt, with one in eight of these people in arrears with their payments. NHS staff, council officials and gig economy workers are among the most regular applicants for such loans. Indeed, NHS workers applied for more loans than any other workers in London, Cardiff and Bristol and applied for more loans nationally than any other organisation’s employees. It is a story that matches those last year about nurses having to use foodbanks. 

Perhaps the recent pay rise announced at the end of March this year will go some way to redressing this situation. The new pay deal, which hasn’t yet been accepted would see pay rises between 6% - 29% for all staff except doctors, dentists and very senior managers. Those on the lowest pay scales will benefit the most. If accepted the pay rises will be phased in over the next three years. Once inflation is included, the pay rises, whilst being most welcome, will probably only keep pace with the projected inflation rate over the next three years.

I am not sure how that will help recruitment and retention in some parts of England. For example, around 30,000 nurses leave the NHS each year. The Royal College of Nursing estimates that 40% of these nurses are considering leaving London over the next five years as a consequence of the very high housing costs in the capital. Sir Robert Naylor’s report, NHS Property and Estates: why the estate matters for patients, published in the Spring of 2017 recognised that the NHS estate was vast, but not always well utilised. It costs well over £8 billion each year to run, and a further £2.3 billion to maintain and improve the wider estate and infrastructure. 

There are clear advantages to the wider NHS of thinking differently about how the NHS estate is better utilised. So I was interested to read last week of the work and ideas of a company called ZEDpods (see here ). They have come up with a really innovative idea to tackle the issue of how to build and install high quality, low carbon homes for key workers and those trying to get on the property ladder for the first time. Thinking laterally, ZEDpods have thought about using the ‘air rights’ to build affordable housing above carparks. For land locked NHS Trusts such as the one I’m associated with, being able to build affordable housing above the car parks we have without losing the use of the carparks must be a win/win solution.   

Additionally, the ZEDpod concept would allow for the development of more ‘step down’ beds – thus helping to reduce the estimated 2.3 million delayed bed days each year. Such a provision would be great for those patients who are medically fit for discharge and have no clinical need to remain in hospital, but have nowhere else suitable to go. Given that Lord Darzi predicts that the NHS needs £50 billion more resources by 2030, anything that can contribute to meeting this need must be welcome. And Shahid Khan, if you want to contribute, feel free.