NHS in crisis?

Facing serious challenges

The NHS hasn’t collapsed – yet. But it is clearly in serious difficulty. At the time of writing, in March 2017:

  • At least 23 hospitals have had to issue ‘black alerts’ - meaning they were unable to guarantee life-saving emergency care.
  • Record numbers of patients were having to wait for 12 hours or more in A & E.
  • Eight out of ten hospital trusts are operating in deficit, with closures planned to try to balance their budgets.

So what has caused this crisis? We believe there are three fundamental issues that need to be addressed.

First, there needs to be an honest discussion about costs and expectations

Politicians, ideally on a cross-party basis, need to have an honest discussion with the electorate about what the NHS can provide, what this will cost and how this will be funded. 

That is important because the UK has:

  • Fewer doctors per head of the population than most other EU countries - 2.8 doctors per 1000 people compared with 4.9 in Spain and 4.8 in Austria.
  • Fewer hospital beds per head of the population – less than 300 per 100,000 people, compared with an EU average of 521.

Second, there needs to be similar discussion about social care.

More older people need care every year but there have been cuts of £4.6 billion in social care since 2010. This is exacerbating pressure on the NHS, with bed blocking a national scandal – elderly patients trapped in hospital beds that are needed for other patients because of lack of care available for them outside hospital.

Third, we don’t have a National HEALTH Service.

Despite its name the NHS is actually a national sickness service. Over 95% of its resources are committed to waiting until people fall ill or have an accident and then treating them. Less than 5% is committed to preventing people falling ill in the first place i.e. ensuring national health.

This matters because so much of the illness we see in the UK is preventable and is caused by:

  • Smoking
  • Excessive alcohol consumption
  • Unhealthy diets
  • Lack of exercise
  • Lack of hope and purpose in life

However, we all know that prevention is better than cure. So if we’re serious about ensuring a sustainable NHS, we need to tackle preventable illness.

Whatever our analysis there are no quick fixes.

  • To ensure we have as many doctors and hospital beds as our European neighbours will take years (and billions of pounds) to achieve, as doctors need years of training.
  • Reversing the £4.6 billion of cuts in social care would be more achievable and would provide some quicker, short term relief. However, with an ageing population, more funding or more imaginative approaches to social care would soon be needed.
  • Tackling preventable illness offers the best long-term solution. It would reduce demand for both medical treatment and social care and help the NHS become financially sustainable again. However, any government would also need to manage a transition period. Before the benefits start to show through there will still be pressure on A & E waiting lists and GP appointments to manage.

Three initial recommendations:

  1. Set a target, in the government’s new Industrial Strategy, for the UK food and drink industry to become global market leader in the mass production of healthier food i.e. lower in sugar, salt and saturated fats and higher in dietary fibre. This should be good for business and good for the nation’s health - starting to address the issue of unhealthy diets at source.
  2. Incentivize organisations to improve the health of employees. This should be a win win for employers – meaning fewer sick days lost, enhanced productivity and improved morale. One simple step would be to add a new indicator to Investors in People accreditation i.e. supporting the physical and mental health of employees.
  3. Increase funding for medical schools and university nursing degree courses, to expand the number of UK health professionals on condition that the medical schools and universities amend their curriculum to include a focus on preventative health – to enable ‘health professionals’ to begin to truly focus on health and not simply the treatment of illness.

Jamie Adem March 2017


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