The NHS’s 70th birthday is being greeted by the same old arguments about money (costs, rationing and sources of funding) and hospitals (A&E waits, postponed surgery, and bed-blocking). This script, sadly, was written for the last big anniversary and the one before it.
These are very important and increasingly urgent issues. But there are others that must also be addressed. I would start with three questions—what do we want the UK’s health system to achieve? How does the NHS need to change? And who needs to be involved in making it happen? Let us examine them in turn.
Clearly, we want our health system to promote the health and well-being of the population and provide high quality services when we need them; however, it does more than that. It supports a healthy workforce which in turn supports economic growth. The NHS with its integrated services, training and structure also provides an extraordinarily robust foundation—which is unique globally—for the UK’s bio-medical industrieswhich are already strong and will become increasingly important in our post-Brexit future.
It is noteworthy that South Korea is investing heavily in its health service alongside its bio-medical industry in a bid to become a world leader in health sciences and health related industries. Yet we with our productivity problems and uncertainties about our economic future are letting the NHS decline while seeking other ways to boost productivity and invest in life sciences. Which strategy looks more sensible?
There is surprising consensus in western countries about the way in which health systems need to change to be fit for the future. Put simply, this is a transition from today’s hospital-centred and illness-based system where things are done to or for a patient, to a person-centred and health-based one where citizens are partners in health promotion and health care. It is a transition which will use the latest knowledge and technology and offer access to advice and high quality services in homes and communities as well as clinics and specialist centres.
“It is good to know that the prime minister is finally taking an interest in health, but she needs a new script and strategy”The NHS policy is to move in this direction, but it is happening very slowly and is all too often hampered by dis-investment in community services—one of the reasons why hospitals are coming under such pressure is that patients too often have nowhere else to go. A transition of this scale surely needs consistency of purpose backed up by transitional funding to smooth out the problems of service change.
The answer to the third question about who needs to be involved is also straightforward: everyone—everyone and every organisation that affects our health from employers and educators to designers, food manufacturers, local authorities and ourselves as citizens. We all have a responsibility for health and can no longer leave it to the NHS and politicians. Change here, too, is underway with pioneering employers promoting the health of their populations, some forward-thinking schools are putting renewed emphasis on physical exercise, and designers working on healthy cities—all of them involved in health creation—but there are also backward steps with the cutting of healthy schools programmes and community services. We need a new understanding about who needs to do what.
It is good to know that the prime minister is finally taking an interest in health, but she needs a new script and strategy to celebrate this latest anniversary. This should involve an investment plan that explicitly aims to maximise the economic as well as health benefits from the health system; accelerates the transition to a community and health-based system; and provides incentives and sanctions which encourage all sectors to promote and improve health.
The harder part is that this needs to be accompanied by the political determination to see health as an economic benefit (not just a cost), to support the transition to a modern community-based system (taking on vested interests) and to mobilise wider society (which is used to seeing this as government’s responsibility and government’s problem.)
There will political blood on the floor if this is to happen—just as there was the last time a prime minister interfered in the NHS in 2000 and produced a bold plan. But there is much to be gained now as there was then, perhaps more.
In 1948 all health services providers were brought together to provide for the whole population, setting the gold standard for the world. Today the prime minister, or her successor, could bring together all the sectors that affect health to build a healthy and health-creating society in the UK—and in so doing put Britain once again ahead of the rest of the world.
