60 Cannon Street,
London, EC4N 6NP
Tel: +44 (0) 20 7710 0020
John is a senior consultant at Media House International (MHI) and the views of the column are John McLellan’s and not that of MHI.
The hard evidence that shows why the old NHS’s number is up
If you are stupid enough to play sports like rugby well past the sensible retirement age, you have no-one to blame but yourself for the consequences.
I had a back injury in my early 30s which put me out for a few weeks but, except for three years editing Scotland on Sunday, plodded on until 50 and now, 12 years later, the result is chronic back trouble which makes walking more than about 20 minutes a very painful experience. Sir Chris Hoy and his wife Sarra put things in perspective, but three GP appointments, four physios, an MRI scan and a private consultant have made little difference, except to my bank balance.
In these risk-averse days, it wouldn’t be surprising if the new UK Government’s review of the NHS in England and Wales proposed trying to stop people doing anything in which they might get hurt – if they can try to ban smoking in beer gardens they’ll try anything – but outlawing things which might be bad for you will make no difference to the crisis facing a service designed in the 1940s when men died on average about two years after retirement.
Peace dividend
It’s only in the last 20 years where the full peacetime effect has been felt when everyone has a notional chance of full life expectancy and not dying early in war; some 380,000 British soldiers died in the Second World War, mainly men in their late teens, 20s and 30s who might otherwise have lived into this century.
And when the NHS was designed, the population was depleted by over a million deaths in the First World War. Combined with medical advances, the rising proportion of elderly people in the population is stark. A fascinating House of Commons study into 20th-century population changes reported that a man born in 1901 could only expect to live till 45, and for women just 49, but discoveries like penicillin and slum clearances meant life expectancy shot up to 66 for men and 70 for women by 1951, but heart disease and cancer replaced pneumonia, bronchitis, TB and dysentery, as the main causes of death.
The latest Office of National Statistics data shows a male born in 2020-22 can expect to live 78.6 years, and female to 82.6 years. Worryingly, that’s a drop of 38 weeks for men and 23 weeks for women since 2017-19, but even so, for pensionable age it still represents a vast change since the Welfare State was conceived in the 1940s.
20 years of ill-health
In 1901, only five per cent of the population was over 65, but by 1945 it had risen to 11.6 per cent, 4.4 million people. The 2022 census in England and Wales found a further rise to 18.6 per cent, and the 2022 Scottish census counted 1,091,000 over 65s, a fifth of Scotland’s 5.4 million total.
A 65-year-old can expect to live another 18.3 years if they’re male, 20.8 years for women, but the issue for the NHS is how long they will be in good health. The figures are not great. Healthy life expectancy in England is 62.4 years for males and 62.7 for females, so the brutal truth is if you reach 65, you are already likely to be calling on the NHS for something, living 20 years or so with one problem or another.
That the NHS is at breaking point is not in doubt, and I spoke to a Scottish board member last week who freely admitted the public has no idea just how bad things really are. Everyone has their anecdotes of good and bad service. A friend recently told me about his experience in Edinburgh when, from realising he might be having a heart attack and calling 999 from his Murrayfield home to lying in an operating theatre at the Royal Infirmary having a stent fitted, was just 48 minutes.
But another, a man in his early 50s, also felt unwell but instead went to his GP surgery. He was told to go home and call back if he felt any worse, which he did, and died before he got to hospital.
£300 for a private chat
My experience of having heart surgery was that the care in the ERI was exemplary, but the process of getting there slow, with nine months between identification of a problem and going under the knife, and reliant on paper communication with hard-copy letters sent second class.
Private health care for routine procedures is quicker because the numbers are lower, but in many ways it just imports NHS inefficiency because it relies on NHS consultants with the same habits. Insurance costs vary considerably, but a non-smoking 60-year-old can expect to pay around £100 a month for cover.
Self-funded treatment costs are eye-watering ─ over £300 just to have an initial chat ─ so without employer cover it’s a very expensive business, but as elective operation queues get longer, it’s a price more people are prepared to pay. The Scottish Parliament Information Service reported there were 46,000 private hospital admissions in Scotland in 2023, up 11 per cent in a year, and 46 per cent were self-funded without insurance.
Where’s Scotland’s NHS review?
At that level, politicians arguing against a two-tier public-private health system have missed the bus because it’s here. Add the recently reported NHS dental deserts, privately-run GP surgeries, private care providers, and the booming number of physiotherapy businesses, and railing against private medicine is doing nothing except pandering to political activism.
Slow as any changes it recommends next year will inevitably be, at least there’s some sort of review under way in the south, but what’s happening here, other than throwing more taxpayers’ money at the same system? Maybe UK Health Secretary Wes Streeting will produce some answers, which hopefully won’t include banning veterans’ rugby, but the starting point must be accepting the old NHS’s number is up.
