Asking for better value from the NHS is fine - but people aren't products Actually, Sir Bruce Keogh is making a narrower point: that the culture of doing more with less applies to almost every economic activity and that healthcare cannot be an exception. He does however highlight - perhaps inadvertently - one crucial distinction between high street retailing and healthcare. Demand for one service is in long-term decline as retailing shifts online, whereas demand for the other is rising fast and, given the changing age structure of the population, will inevitably continue to do so. Every country faces the same problem. Britain is now spending pretty much the same level of GDP as other advanced economies: 9.4 per cent of GDP, just above the Organisation for Economic Co-operation and Development average of 9.3 per cent. The US is exceptional, spending nearly 18 per cent of GDP on health, not necessarily efficiently. Of the rest, we spend rather less than France and Germany (11.6 per cent and 11.3 per cent) but a little more than Italy and Spain (9.2 per cent and 9.3 per cent). We are unusual in the high proportion of the money coming from public funds, 82 per cent - in Germany, France and Italy it is 76-77 per cent. So in terms of the public contribution to healthcare we are pretty much the same as other large European economies. Are we getting good value for that spending? It is very hard to know. Some studies show the UK towards the top of "value for money" leagues; others are less enthusiastic. It depends on what you are measuring. For example, we seem not to be doing as well as we should at treating cancers, but are doing well on diabetes. What we do know is that health outcomes in the UK are not bad, but not particularly good: life expectancy is rising but is still lower than much of Western Europe, or Japan. That points to perhaps the greatest issue of all: to what extent should healthcare be about how you treat illness. Or should it be about how you improve the general health of the population? It must be both, but of course the more healthy people are, the less likely they are to need medical intervention. That is the direction that medical care will increasingly go: nudging people to change their lifestyles and hence improve their overall health. Then the inevitably limited resources can go where they are most needed.