Four organisations examine five central issues facing the NHS
To mark the 70th birthday of the National Health Service, the BBC requested the Health Foundation, Institute for Fiscal Studies, The King’s Fund and the Nuffield Trust to inspect the central issues currently facing the NHS.
Established in 5th July 1948, the NHS was formed under the central principle of health care provided free for all at the point of delivery and financed entirely from taxation, allowing individuals to pay in according to their means.
Over the seven decades since its beginning, however, the Health Service has been pushed to its limits with the population growing and ageing, combined with the development of more complex patient requirements.
Now the world’s fifth largest employer, the NHS faces increasing challenges, particularly regarding funding, with Prime Minister Theresa May in June announcing the budget for NHS England would increase by 3.4 percent a year on average for the next five years.
The five key NHS issues the organisations reviewed were the relative strengths and weaknesses of the NHS, funding, the state of social care, the public’s expectations of the NHS, and the potential of technology to change things in the future.
The Health Foundation stated that these reviews play a vital role in helping transform a system as diverse and complex as the NHS, highlighting that no single structural, funding or technological solution will suffice to bring about the change needed.
In June, the organisations published the five briefings which are intended to inform and encourage a national conversation about the past, present, and future of the NHS according to the Health Foundation.
How good is the NHS?
Briefing authors: Mark Dayan, Deborah Ward, Tim Gardner, Elaine Kelly
At present, the briefing suggests the NHS is not performing as poorly as critics claim nor as well as claimed by supporters in comparison to healthcare systems in comparative countries, with access to healthcare being world-leading. The publication also noted that the Health Service also manages long-term conditions such as diabetes well.
Where it falls short is outcomes according to the briefing, with the NHS lagging behind other healthcare systems for lives saved for leading causes of death, including heart attacks, stroke and various forms of cancer.
Importantly, the NHS is also poorly resourced it found, with lower than average amounts of funding, as well as “markedly fewer doctors and nurses, and among the lowest number of hospital beds and CT and MRI scanners.”
Whilst it admitted that the findings gave a partial picture at best, citing problems with the accuracy of data, the authors stated clearly that the NHS will enter its eighth decade of uncertain health at its current trajectory.
What’s the problem with social care, and why do we need to do better?
Briefing authors: Ruth Thorlby, Anna Starling, Catherine Broadbent, Toby Watt
The briefing found that unlike the NHS, which is free at the point of use, social care is means-tested and remains a source of “a fundamental source of inequity and unfairness today”.
In particular, the document revealed that the social care system is letting down vulnerable older and disabled people who are falling through a safety net which it described as riddled with holes. This comes as the ageing population and increasing number of adults with disabilities is putting greater strain on social care.
According to the briefing, “a funding gap of £18 billion will open up by 2030/31,” based on the current level of spending.
In addition, the briefing pointed out these social care pressures are not a new phenomenon and not unknown to the Government, with 12 green and white papers and five independent commissions published over the last 20 years.
Stating that each Government has ducked the challenge, the briefing calls on the Prime Minister to live up to her pledge to tackle the problem, however, says that reform requires both difficult political collaboration, as well as a challenging process of public education.
Does the NHS need more money and how could we pay for it?
Briefing author: George Stoye
In the briefing, a situation of rising demand for services, longer waiting times for hospital treatment and growing financial deficits across numerous NHS provider organisers mean the Health Service is under considerable strain.
Public sector cuts mean that currently, £1 in every £5 spent by the Government is on the NHS, despite the “the most severe funding slowdown in its history.”
To address the problem of underfunding, the Government has pledged to an average increase of 3.4 percent to the NHS England budget, however, the briefing affirms that this would need to rise by four percent a year to meet rising costs and deliver improvements.
To fund this, a substantial tax increase would be needed emphasised the briefing, pointing out that the UK has a low tax burden against comparable countries and that the public would largely be in favour of a rise of tax is dedicated to the NHS.
Are we expecting too much from the NHS?
Briefing author: Helen McKenna
Examining the interesting question of the public’s expectations of the NHS, the briefing suggests that despite public satisfaction with the Health Service is high and support of the NHS’ principles remains unwavering, there is growing dissatisfaction with NHS services.
Notably, the publication proposes that the public believe it is the Government preventing the NHS delivering the services expected due to a lack of resources, indicating the public will not happily accept rationing services because of budget constraints.
The briefing recommends that “politicians will need to be more honest about the hard choices facing the service” and says “polling also suggests that the public might be more receptive to government intervention to improve health through regulation and taxation than politicians sometimes suppose.”
What will new technology mean for the NHS and its patients?
Briefing author: Sophie Castle-Clarke
Investigating the impact of technological advancements on the NHS and its patients, the briefing says technology can offer significant opportunities to improve healthcare but will not act as a silver bullet for the pressures facing the NHS.
In June, the Institute for Public Policy Research (IPPR) released findings suggesting the NHS could free up frontline time worth up to £12.5 billion a year by investing in a far-reaching programme of automation and technology.
Acknowledging that areas such as genomics and precision medicine are seeing exciting developments, the briefing takes a pragmatic view regarding the NHS’ lacking track record of implementing new technology at scale.
According to the publication, patients are keen to embrace new technology and want to see the Health Service adopt it as well, such as using video consultants to see their GPs about minor ailments.
Additionally, the briefing underlines how new technology could revolutionise the way NHS staff work as well, stating that “the impact of these changes should not be underestimated.”