Seventy years ago this week, a revolutionary institution was born. As the leaflet that announced the formation of the National Health Service avowed, “Everyone – rich or poor, man, woman or child – can use it or any part of it.” With that pledge the NHS became, in the words of its architect Nye Bevan, the “envy of the world”.
But few of us can expect to remain strong over seven decades. The NHS is facing the toughest tests in its history, with an ageing population, increasing demand and ever more pressure on budgets. Our NHS at 70 series takes a deeper look at the current state of our National Health Service as it enters its seventh decade.
The Big Issue: How can the problems with the NHS be fixed?
Ben Gershlick: There is no quick fix for these issues. This is firstly as there may not be a problem to ‘fix’ – the population growing, ageing, and living on with conditions they may have died of 70 years ago is in many ways a good news story. And with that comes increased pressure on the health service due to the prevalence of certain long-term conditions associated with age, as well as a bigger population needing to use the service. The amount required to keep pace with these and similar demands is about 3.3 per cent a year – less than the 3.7 per cent that the NHS has historically received, so not unsustainably expensive by any means.
Why are we making more visits to hospitals than ever before?
This is partly as the probability of receiving elective [non-emergency, scheduled] treatment has increased at every age above 30, with particularly large increases at the oldest ages. This reflects a greater willingness and ability of the NHS to treat sicker individuals even for non-emergency surgery. Increases in the prevalence of diabetes and related conditions have led to a large rise in admissions for metabolic diagnoses. There has also been a large increase in admissions for infectious diseases, mostly due to an increase in the incidence of septicaemia. Activity in other areas, such as pregnancy and mental health or behavioural conditions, has meanwhile grown at a much slower rate.
How does the service provided today compare to its original aims and ambitions?
In a lot of ways, the NHS is set up quite similarly to how it has traditionally been: most formal care is delivered in hospitals, with GPs as ‘gatekeepers’ – referring people to specialists, with care largely provided free at the point of use. However, the profile of patients and conditions has changed considerably, and will continue to do so. While at the beginning of the NHS a focus was on ‘fixing’ people who were ill, more and more people are living with chronic conditions (and increasingly multiple chronic conditions) who don’t just require fixing but also ongoing support and management.
It will require a change of gear in the amount of money going into the NHS
Is the answer more money or are there savings that could be made in the service as it is?
As with any health service in the world, and any industry, there are some savings that could be made in the service as it is – but this isn’t enough. There are some small savings that can be made, and some potentially big long-term benefits that come with care redesign, but the inexorable change in demographics as well as rise in the cost of medicines and pay mean that more needs to be found to support the service. But if we want to maintain standards of care or improve them then it will require a change of gear in the amount of money going into the NHS.
Apart from taxes, how could we contribute ourselves and put prevention at the heart of our approach to health?
About five per cent of the Department of Health and Social Care’s budget goes on funding public health, but the cost to the service of preventable illness caused by behaviours including physical inactivity, diet, smoking and drinking is much greater than that. While people can contribute through working on their own health, the onus is on the government and NHS leaders to develop a level of funding and a plan alongside it, which is adequate to provide the level of care the public desire which is realistic. People’s health is a combination of different factors – many of which are to do with their environment and genetics – and it would be wrong to blame people for the rising cost of health spending.
In the future will costs come down as technology improves, and as we seek better deals with pharmaceutical companies?
Technology and pharmaceuticals have traditionally increased rather than decreased costs, although alongside this is an increase in the quality and productivity of care. As new medicines come on the market they are typically quite expensive, and similarly new technology is quite expensive. There is relatively little evidence that costs are going to decrease rather than increase over the short to medium term as a result of new technology and medicines.
The Health Foundation is a charity committed to improving health and healthcare in the UK.