What can be done to help save the NHS?
The NHS turns 70 this year. In Britain, the average woman lives to 83, the average man to 79. Yet, sadly, the truth is that, while most of us would contemplate major surgery to significantly prolong our own lives for a decade or more, as a nation we seem unable to contemplate the same for our own, treasured national health service.
The NHS is the core of the care system that we have in our country. It has remarkable strengths, and by international standards is as competitive, efficient and, in outcomes per pound spent, as good as anything in the world. But, as is becoming increasingly clear, it faces a number of formidable challenges. The population is ageing. Chronic diseases like diabetes are becoming more prevalent and already absorb most of the NHS budget. Costs are rising but budgets and funding are not. Since it was created the NHS budget has risen by 3.7% in real terms each year. In the last few years it has grown by less than half that rate – a factor which is likely to have had a significant impact on performance and waiting times.
It cannot go on like this. Without the right level of investment, the NHS will go the way of its sister service - social care - and buckle under the pressure. It faces a stern test in the months to come. The National Health Service, is at its weakest over winter. In the last one, the gap between demand and supply became clear as dozens of hospitals reported an ‘inability to provide comprehensive care’ to patients. Hospital chiefs are already calling for a cash bailout to get it through the next winter, amid the recent warnings of a severe flu outbreak from NHS Chief Executive, Simon Stevens. The Chancellor would be sensible to heed the warnings and use his autumn Budget to forestall a fully-blown NHS crisis. Indeed, he should go one step further and start preparing the ground for a long-term sensible funding settlement for our overstretched care system.
But something else is needed too. As the US proves, simply throwing more resources at healthcare won't by itself bring about sustainable improvements. In America, they spend twice as much as we do on healthcare but outcomes are no better than in the UK. That is why reforms are as important as resources.
The reason is simple: the challenges facing healthcare today are different from yesterday. Perhaps more importantly, the opportunities for healthcare to do more will make them different still tomorrow. In the public debate about the NHS, the talk is much more of daunting challenges than it is of major opportunities. A sense of possibility is missing.
Yet the world is on the verge of a huge leap forward in healthcare, driven by advances in knowledge and in technology. We now know much more about how the brain works and the impact the broader environment in which we live our lives has on our mental health. We know more about how our gut works and the impact food and diet can have. The advent of big data and predictive analytics mean we can better plan care for a population. Advances in genomics are changing our thinking from diagnosing and treating illness to instead predicting and preventing ill-health. The development of precision medicine will increasingly allow a patient to be treated as an individual not just another number. An influx of new mobile devices and bio-devices will mean we will be able to check - and take greater control over - our own health in a way that was never previously possible. These kinds of new innovations also enable organisations to make better population and individual healthcare decisions.
All of these big changes are underway. They will accelerate in the years to come. The question that policy-makers should be focusing on now is how to harness them to improve the health of the nation. That will mean making big changes to the NHS, not just putting in more cash. Many of the technological changes we are seeing do not emanate from the public side of health at all. They come from private players. For example, biopharmaceutical company AbbVie has launched Live:Lab – a collaborative, preventative health initiative – led by technology – designed to alleviate strain on the NHS by reaching out to people (less likely to engage with public health information) in a more compelling way to help them overcome their fear of finding out about their health. It is no coincidence that all of the big tech players have placed big bets on the health sector. The future of healthcare will involve forging new networks with the Googles, Apples, IBMs and Facebooks of the world; whilst maintaining strong relationships with the charity sector and not-for-profit organisations. Additionally, the third sector continues plays a vital role in providing the hard-to-reach communities with a voice, both from and via the power of social media which gives us an invaluable insight and way into this group.
The NHS itself too needs to face outwards to go with this tide of innovation instead of seeking to stand in its way.
The cyber-attack on NHS Trusts that occurred in May 2017 reinforced for many fears about advances in technology and the potential threat it poses to individual privacy. Of course, the right safeguards are needed but perhaps it is time we stopped seeing the internet and data as a threat to health, rather than something that can be harnessed for the common good. Technology is never neutral. It can be a force for good or ill. But in healthcare the time has come to move our mindsets to embrace it instead of resisting it.
In country after country, change will have to happen not just because cash is running out. But because time is running out for health systems that were designed to deal with yesterday’s challenges not tomorrow’s opportunities. If we can summon up that same spirit of creativity and courage that created the NHS in the first place we can reshape how care is delivered so that we improve outcomes, optimise resources and empower patients. That would ensure the NHS is able to outlive us all.
This article was written by Alan Milburn, Live:Lab chair and Former Secretary of State for Health. It originally appeared in the Guardian.