(Photo: Dr Sam Shah)
By Max Abdulgani – Deputy Editor
Over the last decade, the National Health Service has undergone some of the most significant and damaging crises in its entire history. Waiting times are the highest since records began, at 7.2 million. There are over 400,000 patients waiting over a year for treatment, as well as a hidden backlog of pre-COVID treatment that never took place. On staffing, the NHS needs almost 500,000 more combined jobs to cover capacity by the start of the next decade alone. The tremendous scale of this shortage is detrimental to patient care and has resulted in a chain reaction. Ultimately, this is driven by a persistent culture of low pay and poor working conditions. Rampant underfunding in the NHS has also seen the decline in services capable of dealing with the challenges patients face on a daily basis, including the £37 billion funding gap from the last decade needed to build up operational capacity and give fair pay rises to staff. But these aren’t the only problems facing the NHS.
Since it came into office in 2010, this Conservative government has been absent not simply on investment but on reform too. A service that has been in existence for over 65 years and is widely regarded as the most successful political project this country has ever achieved cannot be adequately maintained without adapting to the times in which it operates. The reality is Britain has a woefully poor record on both public service investment and reform, particularly in health. It doesn’t take a pundit or a politician to know that the NHS is not fit for purpose in its current form. When we look holistically at the fundamental challenges posed towards healthcare in the 21st century, it is abundantly clear that fundamental reinvention is needed. A long-term plan for the future of the NHS and its long-term maintenance has been left out of policymaking and left out of political discourse.
For a start, the development of technology within clinics has been sluggish and ineffective; failing to catch up with nations such as Israel who have one of the most technologically advanced healthcare systems in the world. Wearable tech that measures heart rates, body temperature and sleeping patterns has the potential to face widespread expansion. Soon this could include brain physiology and hormone levels. Non-urgent appointments conducted through apps to reduce waiting times and diagnose patients more quickly without taking up capacity needed for more vulnerable patients. Through scientific advances such as genomic sequencing, viruses can be identified early, and future pandemics can be more easily prevented and based on prior research and planning as opposed to responsive measures. Lack of pandemic preparedness can be mitigated by the meaningful impact of technology on healthcare, but underfunding combined with poor policymaking has prevented progress in this area. Global infrastructure for digital vaccination status is yet to materialise, despite the significance of not implementing this. At present, managers as well as clinicians don’t possess the resources necessary to sustain a health system fit for the 21st century, let alone to bring the next generation of doctors, nurses and paramedics into the profession.
The second point is about a unified recognition from policymakers that healthcare is about prevention and not just provision. This involves an entirely new philosophy and policy platform to accompany it. 1 in 4 patients shouldn’t be in hospital beds in the first place. They end up there because of an abject failure of governance to deliver a social care package that can meet three particular challenges. To improve the mental wellbeing of those who need it and boost resources to allow early intervention from GPs and Occupational Therapists. To reduce overcrowding in hospitals and divert mental health to a new, radical plan for a National Care Service capable of achieving this. And to deliver care that is good value to the taxpayer and does not require a bottomless pit of funding. This would involve a huge degree of resilience from health ministers tasked with these reforms. The absence of preventative medicine in pharmacies across the country to tackle mental illnesses before they develop is also an ongoing problem which needs to be tackled.
The NHS, whilst in crisis, is not beyond repair. But a mass capacity build-up within the public sector can only happen in the long term. A decade at least is required to build this capacity to an adequate level. The construction of over 40 hospitals and the recruitment of half a million staff won’t happen quickly. The problem is we need action now, because the public can’t and shouldn’t have to wait any longer for appointments. If this means using up spare capacity from the private sector to deliver lower waiting times, then this should be considered. After all, it is an ideological extravagance to suggest we can go on as we are and plough more money into the health service without evaluating where this flow of money goes, and which targets are hit. Reform means making decisions that not everyone will agree with or favour, but it’s what the last Labour government did. The results were phenomenal. Waiting times fell to a median average of 4 weeks, compared to 14 weeks before 1997. Spending since then has doubled to more than £100 billion in England alone. The introduction of foundation hospitals brought elements of competition and choice into the equation so patients could choose their own path for treatment. The government back then ditched their initial platform of ‘command and control’ when they realised that the NHS could not be run from an office in Whitehall. Ultimately, control must be delegated to the providers of the service. This still applies today.
Since the NHS began, one of its founding principles has been to remain free-at-the-point-of-use. Successive governments have all kept this principle. Not least because no government would have the political capital to remove it, but also because it works. Britain prides itself on a system of healthcare that doesn’t depend on the size of someone’s wallet, but on the scale of someone’s need. If this principle dies, the NHS will die with it. Some political figures including former Health Secretary Sajid Javid have publicly called for a social insurance system similar to the likes of other European nations, most notably Sweden. Using a decade of underfunding to pursue a case for an insurance system is immoral but is exactly what some Conservatives want. It is the duty of future governments to defend the first principle of the foundation of the NHS and argue the case for why a social insurance system would be a complete disaster for patient care.
A publicly funded NHS is paramount to the basic principles of a free and fair healthcare system and should provide patients with a service we should be proud of. But the problems of the NHS now dwarf the problems it faced over 25 years ago. Healthcare must be reinvented. The profound needs to modernise as well as sustain, to reform as well as invest, to prevent as well as provide are clear. Britain doesn’t deserve to wait any longer for this set of changes so desperately needed, it needs to be phased in by the government now. The longer we wait, the longer we suffer.
The York Politics Review 