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The NHS at 70: celebrations, renewed reforms and difficult choices

Health service remains popular with public, but faces daunting need for radical change


As the UK National Health Service marks its 70th anniversary today, amid all the appropriate celebrations, questions about its long-term future and how it should adapt have come to the fore.

The health service's popularity remains very high among the general public, but fears about its future are also a recurrent feature of opinion surveys.  A poll held in May by MORI found that when asked to consider the NHS over the next few years, 21% expect it will get better, 31% said it will stay the same and 46% said it will get worse.

The 70th birthday has been preceded by much debate not just about the history and the present condition of the NHS, but also, of course, its long term future. Many of these concerns are rooted in the funding of the NHS in England, which has seen its budget growth restricted to an historic low over the last five years. This still leaves it in line with an unweighted EU-15 average of 9.8% of national income, but far behind countries such as the US (16.9%), Japan (11.2%), Germany (11.1%) and France (11%).

A survey commissioned by the NHS Confederation has today revealed that four out of five people (84%) would be prepared to pay more in tax to fund major improvements.

The result from the NHS Confederation commissioned poll come after the UK government agreed to a five-year funding deal that will see NHS funding increase 3.4% a year on average, up from 2.3% per year over the last five years – although that is still below the 4% that the Institute of Fiscal Studies (IFS) recently said would be necessary to cope with rising demand and to ‘modestly’ improve.

The poll commissioned reveals that three quarters of the 1,000 or so respondents said they would pay more even for slight improvements to the NHS, and almost two-thirds (61%) would do so even to keep services at current levels.

At 70, its apparent that the NHS – like most who reach that age – isn’t in perfect health. There is no doubt that there are big problems with long waiting times for procedures, difficulties in getting GP appointments and referrals, staff shortages that may be exacerbated by Brexit, and cancer survival rates well behind other countries in Europe.

While the NHS is one of the country's most popular institutions, it does have some vocal critics - many of them in the press. The Telegraph newspaper's editorial today rails against what it calls the NHS' "insatiable appetite for taxpayers' money" and called for a break away from its "idealogically untouchable" founding principle of "free at the point of delivery" care.

Such a stance is unlikely to be adopted by any UK government, but this and future administrations face difficult decisions on public spending. The government may welcome the willingness of the UK public to pay more, but the Treasury continues to be wary of the growing proportion of public expenditure the NHS takes.

Prime Minister Theresa May recently suggested that the increase in spending on the NHS would come in part from a 'Brexit dividend'. That notion has been dismissed by most independent experts, who forecast that Brexit will continue to have negative impacts on the economy, which is likely to trump any money saved from EU contributions.

This means that the additional cash will have to be raised from higher taxation, and the government is preparing voters for a tax rise in the autumn.

...but it’s not just about the money

Meanwhile, the NHS Confederation – which represents the bulk of the NHS’ providers and commissioners – agrees that the service needs not only more money, but also sweeping reforms to its operations, for example allowing patients to be treated closer to home.

In its survey, 42% of participants agreed that any extra funding for the NHS should focus more on providing care closer to home and less on hospital care, while just 18% disagreed with that principle.

“The poll shows that the British people are willing to pay more for better care and that there is an understanding we have to change the way we deliver care – we cannot go on as we have been,” said NHS Confederation chief executive Niall Dickson.

However, he added that “just pumping money into a struggling system will not work. Healthcare must be patient-centred, with more focus on primary care, community health services and social care, all of which can help ensure people receive quality care in or near their own homes.”

Simon Stevens R4 Today programme

Key to the future of the health service in England will be the Integrated Care Organisations (ICOs), which aim to bring together health and social care services, both to improve patient care and also to reduce waste and costly hospital treatment. With remarkably ironic timing, a judge reviewing a legal challenge to their introduction is set to make his ruling later today.

NHS England chief executive Simon Stevens was interviewed on the BBC’s Today programme (pictured here at the BBC with the original NHS leaflet) this morning to talk about the health service's future. While outlining the progress made over the decades, such as steep declines in heart deaths and infant mortality, he conceded that more improvements would be needed in the coming years. He also highlighted a clampdown on waste, including the ending of unnecessary prescriptions and services which could save £500m over the coming year.

Stevens praised the 'brilliance' of the NHS staff who make the service work, and welcomed the recently announced funding increase as a 'gear change'. He concluded that there was no reason the health service couldn't continue to improve outcomes and adopt new technologies and techniques towards this goal - but independent experts warn that a lack of money will present some serious challenges.

A big part of the next 10-year plan for the NHS, due to be drawn up in the next few months, will be to ensure that healthcare elements such as GP services, community nursing and social services to move towards integrated systems in order to reduce hospital admissions. At the moment there are 12m people in England covered by ICOs and similar organisations, and that will be extended across England in future, said Stevens.

Richard Horton, the editor of The Lancet, insists in a Guardian article today that the NHS should no longer be viewed as a cost but as an engine of growth for the economy through “improved labour supplies, social cohesion and health security.”

He added that serious reforms are however needed for the “struggling and outdated” health system, including an end to the referral model of primary to secondary care, tackling social issues that lead to poor health such as poverty, and upgrading the quality of NHS workers.

This is a very similar argument to that put forward by the UK's life sciences sector, including the pharma industry, which believes faster uptake of new medicines and other technologies will not only improve outcomes and make the NHS more efficient, but will also boost the UK economy.

The UK pharma sector and NHS are increasingly willing to work together on mutually beneficial projects to improve patient care, such as Greater Manchester's health devolution initiatives. However, the increased budget squeeze in England, combined with a wave of new highly specialised and high cost drugs is also inevitably causing conflict.

Today produced a clear example of this, with Vertex today saying it was "outrageous" that NHS England has not accepted their latest pricing and reimbursement offer on its cystic fibrosis drug Orkambi.

Article by
Phil Taylor

5th July 2018

From: Healthcare



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