Opinion

The NHS at 75: How do you fix the broken, beating heart of a nation?

The NHS is on its knees but leading doctors and campaigners have ideas for how to get it back on its feet.

A knitted crocheted postbox topper appears on a red post box in Poole, Dorset as 5 July 2023 marks 75 years of the National Health Service NHS which treats over a million people a day. Credit: Carolyn Jenkins/Alamy Live News

The NHS is a source of pride in the UK. For months in the pandemic we stood outside our doorsteps every Thursday night, clanging wooden spoons against metal pans showing just how thankful we were. We watched as doctors and nurses formed the frontline, battling against COVID 19. We felt lucky to have them.

The tone has changed somewhat since then, with record-high waiting lists and striking medical staff. A&E on a Saturday night isn’t exceptionally chaotic like it once was, it’s like that all the time. Underfunding is endemic.

Years of austerity combined with Brexit and the pandemic has left behind a deeply scarred system. It needs to be celebrated, certainly. There is still incredible work being done in NHS services all over the country and 75 years of free healthcare is something not many countries can boast. Despite its brilliance, many services now have problems so deep routed they require a complete overhaul.

Politicians seem hesitant to prescribe anything better than a broken promise, so we asked NHS experts and health campaigners what the NHS really needs for its birthday this year.

Sir David Haslam: ‘We have underinvested in so many aspects of the public’s health’

Back in 1948 it seemed a revolutionary idea. A National Health Service, free at the point of need, funded through taxation, offering high quality care irrespective of ability to pay. But, as all too many pundits are now asking: Is it an idea whose time has passed? Do we need to think again? 

It needn’t be. In the short term, it certainly needs more cash. Just look at the extraordinary impact of increased funding after the year 2000 – almost every measurable metric improved, from waiting times to patient satisfaction. Money really matters. And retaining and recruiting great staff really matters too. Healthcare is a human business, and needs kind, compassionate, skilful humans to deliver it. 

But its future ultimately needs much more than just cash. It needs to refocus on the changing needs of the population and in particular the revitalisation of general practice. Accessible, personal, and effective general practice – where the patient knows the doctor and the doctor knows the patient can make a massive difference to our health.  

Research in 2021 showed that patients who stayed registered with the same GP over many years had fewer urgent hospital admissions, as well as a 25% reduced risk of premature death. If drugs produced benefits of this scale, massive investment would be found to provide them.  

Instead, there has been an over-focus on hospitals and hospital care, rather than downstream where so many problems could have been averted through prevention, public health, and quality primary care. As Archbishop Desmond Tutu said: “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”

And they often fall in because we have underinvested in so many aspects of the public’s health. We close swimming pools and playing fields, then wonder why the NHS is overwhelmed by the unfit. We forget that housing, nutrition, sleep, stress, education, exercise, social isolation, and poverty are key determinants of our health. We focus on the dramatic rather than the effective. The headlines get the attention. This does not always lead to the wisest of choices. 

But get the choices right, and the NHS can still have a glorious future. 

Sir David Haslam is the former president of the British Medical Association and past chair of the National Institute for Health and Care Excellence. His book Side Effects: How our healthcare lost its way, and how we fix it was published by Atlantic Books in 2022.  

Dr Julia Grace Patterson: ‘We must hold politicians to account and reimagine the NHS’

The health of a nation is a key determinant in the happiness of a nation, the economic productivity of a nation and the overall progress of a nation. The NHS project therefore goes far beyond individuals’ health issues. It goes beyond the patients on waiting lists and affects us all, and this is why the NHS is so important. This is why we must fight for it and stand up at this important milestone to demand better from our politicians.  

The problems in the NHS are not the fault of staff, and they are certainly not the fault of the public. They were predictable, and predicted, and they have been caused by politicians. We need to call for many things, together. We need private outsourcing to be eliminated. We need the PFI debt, which costs us billions every year, to be paid off. We need the staff to be properly supported in pay and in their general workplace conditions. And once these things are done we need to start imagining an NHS fit for the next 75 years. An NHS where the leadership mirrors the changing demographics of our population, an NHS with the facilities our communities truly need, an NHS where sustainability is at the centre of decision making.  

We are at an important milestone, a crossroads, and we must take this opportunity to hold politicians to account and reimagine what we want from the NHS; bold, transformative, necessary ideas which will carry this extraordinary project forward for another 75 years.  

Dr Julia Grace Patterson is the chief executive of EveryDoctor. Her first book, Critical: Why the NHS is Being Betrayed and How We Can Fight for it, is out now (Harper Collins, £16.99)  

Professor Azeem Majeed: ‘GPs are at the heart of the NHS’

A strong primary care system must be at the heart of the NHS to enable the delivery of accessible, cost-effective, high-quality health services to the population. Over the last decade, we have seen problems developing with general practice services in England; leading to frustration amongst the public due to the difficulty that many people experience in trying to book appointments for themselves or their family.

To rectify, the NHS must improve the recruitment and retention of GPs. No initiative to strengthen primary care will be successful without a well-motivated, sufficiently-large clinical workforce. NHS England and Integrated Care Boards need therefore to be much more pro-active in this area. One key aim should be to make working in an established role as a GP partner or salaried GP more attractive than working as a locum GP. Currently, the balance has swung away from established employment and this needs to be addressed urgently. This requires supporting locums GPs and making the changes necessary to bring them back into established roles in the NHS.

A career structure for GPs and other clinical staff who work for out-of-hours and urgent-care services in place of the very fragmented employment we have now is also essential. With better recruitment, retention and career structures, we can expand capacity in general practice, make it easier for patients to book appointments and address their health needs, and provide the continuity of care that leads to improved patient experience and better clinical outcomes. 

Professor Azeem Majeed is Professor of Primary Care & Public Health at Imperial College London. 

Mark Rowland: ‘Mental health problems can be prevented if we support people at the right time’

While proper funding and staffing for our health service is vitally important, we know we can’t ‘treat’ our way out of the current crisis. We need health systems focused on prevention and health generation. With mental health being the single biggest cause of disability, we need to invest in evidenced based programmes to prevent poor mental health and tackle the root causes of poor mental health, including poverty, racism and trauma.

Mental health problems can be prevented if we support people at the right time and tackle the inequalities that drive them. The same can be said for non-communicable diseases such as many types of cancer, type 2 diabetes, heart disease and stroke, all of which are experienced more acutely by people living in areas of deprivation. A preventative public health approach is needed here too.

To reduce demand on our NHS, we urgently need the UK government to develop and deliver a long-term strategy, specific to mental health, that increases investment in prevention. Early interventions and targeted support programmes are some of the most effective tools we have, both to protect the health and mental health of people living in the UK, and reduce strain on stretched services.

Thank you to our inspiring NHS staff, and to those of you delivering services and opportunities in the community. Thank you for all you do.

Dr Habib Naqvi: ‘Inequalities must be tackled urgently’

The NHS is perhaps the most visible expression of a shared social contract between people. But to be proud of the NHS is not to be blind to its imperfections – these include the unjust, immoral and simply unjustifiable differential experiences that we see in the workplace based upon race, and other characteristics. No one should be exposed to bullying and harassment, glass ceilings to promotion or inexcusable pay gaps in the workplace.

And so, whilst we honour its 75th anniversary, we know there is still a lot to do around staffing concerns and health inequalities faced by communities. These inequalities must be tackled urgently along with issues around strikes, long waiting lists, recruitment, bed blocking and access to good healthcare.

Workforce race equality data also tell us how important it is for the NHS to keep steadfast in its pursuit of understanding, and actively improving, the experiences of its diverse workforce. The NHS is the largest employer of Black, Asian and ethnic minority people in England; it is vital therefore that these staff are provided with equality of opportunity with regard to recruitment, career progression and promotion, as afforded to their White colleagues.

We know that to help improve health outcomes, we need granular ethnicity data and insights, recorded across the NHS to address key shortcomings. We can’t afford to have optimum healthcare evaded for future generations of people from Black, Asian and minority ethnic backgrounds. It is not acceptable that these communities are subject to a range of preventable heath conditions and inequalities. We therefore need to ensure legislation and accountability frameworks are enablers for tackling the root causes of inequalities, with prioritised action heralded by leaders and providers across the NHS.

This is a key mission for us at the NHS Race and Health Observatory, an independent body hosted by the NHS Confederation and supported by NHS England and NHS Improvement was formally established in April 2021. Our work brings together research, evidence and insight around long-standing health inequalities affecting ethnic minority patients and communities and provides policy recommendations on the basis of that insight. We also support the NHS to implement recommendations and provide implementation support. Some of our current workstreams include maternal and neonatal healthcare, mental health, sickle cell care pathways, genomics and genetic testing, digital access to healthcare as well as the challenges following the impact of the Covid-19 pandemic.

Across England, hospital activity continues to be seriously impacted by the Covid-19 pandemic with large falls in routine care resulting in millions of patients now subject to vast backlogs. We have looked at data with the Nuffield Trust, which shows people from Asian groups faced larger falls in planned hospital care – both before and during the pandemic than people from White, Black or Mixed ethnic groups.

We’ll continue to highlight research, evidence and tangible actions the NHS can take to address ethnic and racial disparities in access, experience and healthcare outcomes.

Dr Habib Naqvi is chief executive of the NHS Race and Health Observatory

Do you have a story to tell or opinions to share about this? We want to hear from you. Get in touch and tell us more.

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