5th July 2019 - The 71st anniversary of the NHS
The War is won. National pride and solidarity run deep.
The British government embrace the possibilities. They hold their breath and declare “FREE HEALTH FOR ALL!”.
The warm flow of national progress pours into the seams of society. This is the new normal. And people are pleased. - - - -
71 years later, and the government’s pledge is groaning under the weight of £4m linear accelerators, state of the art facilities and flat screens in waiting rooms.
It’s unsustainable, of course. Appointments are cancelled; patients spend hours adrift on plastic chairs – the air-con isn’t working. The only grace is precious time to post social media derision.
Behind the scenes, Top Hats clock overtime at long tables, brainstorming ways to rake money from other emptied pots or keep people away though marketing campaigns and fruit-based diets.
But there’s nowhere to go from here. As the roar of fast flowing patients fills the beds; quietened only by the clinical whirr of bitter disdain the wet sqwitch of sad, rolling eyes.
And the world looks on. Amazed.
71 Years of the NHS
In 1948, the UK government launched their free health service to a grateful post-war generation.
Nobody could have predicted how the NHS would transform - in less than a century - from a glass-and-rubber operation to a laser-guided monster of money crunching complexity.
The NHS budget expectation hit £123bn for 2019/20. That’s £1863 spent in one year for every child, woman and man in the UK.
In 2018, almost 1 in 3 of us (23.4 million people) went to A&E.
With numbers like that, it’s little surprise then that our health service is facing pressure.
Problems aside, the NHS is still No.1
While the future of the NHS relies on us addressing the issues it faces, it’s important not to create a distorted picture.
The NHS is one of the top health services on the planet.
The 2014 Commonwealth Fund Report ranked the UK health service – from 11 wealthy countries across Europe, America and Australasia – No.1 for overall provision; for quality of care; patient access; and efficiency.
But like for all health providers, pressures continue to mount.
What are the current pressures on the NHS?
The NHS is bending. That’s no secret. Largely because it’s facing heavy pressure from both supply and demand.
RISING DEMAND FROM:
1. Our ageing society
Did you know…
• Nearly two-thirds of people admitted to hospital are over 65 years old.
• Older people stay longer in hospital.
• The NHS spend 13 times more to treat people in hospital who are over 75.
2. The rise of long-term conditions
Did you know…
• 30% of people with long-term conditions account for £7 of every £10 spent on health care in England.
3. Increasing expectations
Did you know…
• Today’s patients want seven-day access to convenient primary care.
• We want coordinated health and social care services, tailored to our own needs.
• We also want air-conditioned hospitals, parking spaces and to be seen ‘on time’.
PRESSURE ON SUPPLY FROM:
1. Increasing costs of providing care
Did you know…
• The NHS can now diagnose and treat more conditions.
• Many healthcare innovations cost more than the ones they replace.
• In England, the NHS faces a funding gap of around £30bn between 2013/14 and 2020/21)
2. Stalling productivity gains
Did you know…
• Between 1995 and 2010, overall economic productivity grew at a rate of 2%. The NHS grew by 0.4%.
Is the NHS answering this challenge?
The stats paint an uncomfortable picture. But the government and relevant bodies are investing in the technology, training, and reform initiatives needed to create a more sustainable NHS. How long it’ll take is anyone’s guess, but to get there a few hard facts will need to be faced.
The 4 hard facts…
1. The technology isn’t new anymore
Moving something huge takes time. Especially when it’s cemented with fearful and outdated approaches. Nobody expected the NHS to go paperless overnight (or even by 2020!).
You know that the NHS needs investment in technology. You might not know that this technology - which could transform the way patients access and use NHS services - is now over 20 years old.
Online banking was first introduced to the UK in 1998. Now more than 55% of internet users have online banking services.
If a fully integrated online model was introduced to the entire health service – giving access to medical records, online test results, appointment booking, and email consultations with individual clinicians – it would lift pressure from services across the board.
Global Digital Exemplars
To speed up efficient use of technology in the NHS, the government created the Global Digital Exemplars (GDE) programme. GDEs are internationally recognised NHS providers, who ‘champion NHS digital excellence’. They focus on delivering improvements in care through world-class digital technologies and information.
Exemplars share their learning and experiences to allow other trusts to quickly follow in their footsteps.
As of Feb 2018, there were 16 Acute and 7 Mental Health Trust Global Digital Exemplars, receiving up to £10 million and £5 million, to be matched by investment by the Trust.
2. Changing culture is crucial
Today, in our digital life, society ticks to the clock of convenience, instantaneousness, and simplicity.
The stumble for many NHS managers is attempting to integrate new thinking and new ways of working within their teams: adopting cleaner admin, faster communication, easier meetings or making services more accessible.
If staff (or patients) are resistant to change, the solution is finding a way to remove the fear and influence their thinking towards better ways of doing things.
Usually, the only answer is good training.
Recently, the government has invested £6 million in an NHS Digital Academy to train the aspirant digital leaders of the future.
3. Spending will increase as more lives are saved
Among the brilliant minds of our health industry, new methods and technology are becoming available to save more lives. This welcomed fact is great news for us all. As we enjoy the benefits of living longer, healthier, happier lives.
The unwelcome truth, however, is that for every great idea comes a financial cost. Here’s an example:
Case Study – saving more lives with eICU
A London NHS Foundation Trust recently deployed a new e-Intensive Care Unit. It’s been designed to keep a ‘second pair of eyes’ on critically ill patients.
It does this by remotely monitoring patients using high-definition cameras, two-way audio and other instruments that keep track of vital signs.
Not only does the system allow 24/7 care, it also enables the most experienced specialists to spread their skills more widely and to help more patients with the greatest need.
This is a great example of technology being used in the right way – saving lives, freeing up staff, reducing the patient burden. But it’s also an example of how the NHS is investing more money to save more lives, at a greater cost. The NHS is an institution based on delivering the maximum good to the maximum number of people. Whether or not this is part of a sustainable model of healthcare is unclear. Presumably, and unfortunately, a line may eventually need to be drawn.
Answering the call for increased productivity
For now, though, drive to increase productivity – and target the shortfall compared with the wider economy – has been addressed by The House of Lords NHS sustainability report.
The recommendations include financially rewarding organisations and leaders who drive change in levels of productivity, the uptake of innovation, the effective use of data, and the adoption of new technologies.
4. The NHS needs breaking out of its box
Long ago, building a local town hospital and a scattering of GP surgeries was enough to meet our healthcare demands.
Today, individual hospitals cannot withstand the pressures on them. Some believe the answer lies in spreading the burden of healthcare delivery to a wider, more accessible, more cost-effective network.
To make healthcare accessible to all, digital inclusion needs taking seriously. For the last few years, funding has been given to online centres in wider local settings, like libraries, community centres, cafes and pubs. These digital health hubs enable people to find support to go online for the first time and use technology and information services, like NHS Choices. It takes the burden away from centralised health centres and delivers services into the heart of communities.
Data is a currency of the modern age. Data collection has some negative connotations these days. But by gaining and using patient data in positive ways, commissioners can better understand how effectively money is being invested. For patients, more and better data will enable them to make informed decisions about their health and healthcare provision.
The health service spends a high proportion of its time and money on a relatively small minority of patients. Understanding who patients are will help the NHS offer more effective, more efficient care. It can do this using intelligent data, online services, and tools focused on gaining information. This will allow the NHS to better manage its patients and budgets – and to help patients manage themselves – through an intelligent understanding of individual needs and risk.
How many more years?
It’s clear that the NHS is facing huge tests. For some, the tide has already begun shifting towards more privately-funded solutions, at the expense of free and open access to all.
Whether or not this can be avoided, considering the current climate, remains a hopeful challenge.
But the truth is that all healthcare systems face challenges. Health provision is a life changing matter. Whether funded publicly or privately, expectations on health services in wealthy countries will always be fierce.
But if we want an NHS that is recognisable at 100 years, we need to bring it with us into the modern age.