SUSTAINABLE AFFORDABLE HEALTHCARE
THE INTERNATIONAL HEALTH CARE TIME BOMB: TIME FOR ACTION
Governments have long sought – often with limited or no success – to provide more and better health care at a sustainable price. The United Kingdom’s National Health Service is about to test a new response to this global dilemma which a leading British specialist argues can meet both soaring demands and soaring costs.
Prof. Tim Briggs and Mr Jonathan Perera in London. Prof. Tim Briggs, MBBS (Hons), MCh (Orth.), MD (Res.), FRCS (Ed.), FRCS (Eng.), has advised British Ministers. He is a consultant orthopaedic surgeon at the Royal National Orthopaedic Hospital of England, Vice- President of the British Orthopaedic Association, Chair of the National Clinical Reference Group in Specialist Orthopaedics and Chair of the Federation of Specialist Hospitals. Mr Jonathan Perera, MRCS, is an orthopaedic training registrar at the Royal National Orthopaedic Hospital of England.
The United Kingdom National Health Service (NHS) has provided unrivalled, world-renowned healthcare since its inception on 5 July 1948. Its objectives are to meet the needs of everyone, be free at the point of delivery and be based on clinical need and not on ability to pay. The NHS is one of the largest employers worldwide, employing approximately 1 in 20 of the United Kingdom’s working population. Staff are in contact with more than 1.5 million patients on a daily basis. The importance of the continuance of the NHS to the U.K. population cannot be understated. This has led to it being a focus for politicians of all parties in their manifestos and at general elections. The cost of providing free and timely healthcare, in these times of severe austerity and huge national debt, for an ageing, demanding population is a significant challenge that must be tackled. One healthcare discipline is a
prime example of the challenge. Musculoskeletal disorders are the leading cause of time off work for sickness, and of disability contributing
40 | The Parliamentarian | 2013: Issue One
to the 2.5 million unemployed in the U.K. We currently spend £10 billion a year on musculoskeletal disease, which equates to almost 10 per cent of the total NHS spend of £110 billion. By 2035, 23 per cent of the population in the U.K. will be over 65 years. An increased life expectancy, and other factors such as obesity, will further increase the demand from patients needing orthopaedic care. The NHS and all world health
services are under pressure to meet increasing demands and patient expectations within increasingly stringent budget limitations. The NHS is about to embark on a pilot project to test a different approach to this problem which I maintain will improve care while containing costs.
Rising demand Currently, 25 per cent of all surgical interventions within the NHS are for the treatment of musculoskeletal disease. This is set to rise significantly over the next two decades. There are approximately 400,000 patients on orthopaedic waiting lists at any one time, with more than 120,000 waiting for more than 18 weeks for treatment
Prof. Tim Briggs
and over 50,000 for more than six months. In 2010, over 180,000 hip and
knee replacements were carried out, an increase of nearly 300 per cent compared with the previous six years. Over the last five years, there has been a 92 per cent rise in revision knee and 49 per cent rise in revision hip replacements (a second operation on the same joint). A total of 35 per cent of hip and
knee replacements are now carried out in patients below retirement age, and 12 per cent below the age of 55 years. This is leading to an increasing huge burden of cases needing future
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