The NHS is the core of our care system. 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 formidable challenges. The population is ageing. Chronic diseases such as 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. The impact on performance and waiting times is obvious.
It cannot go on like this. Without the right 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. It 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 this 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 full-blown NHS crisis. Indeed, he should go one step further and start preparing 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 bring sustainable improvements. In America, they spend twice as much as we do on healthcare but outcomes are no better than in the UK. That’s 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 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 technology. We now know much more about how the brain works and the impact that the broader environment 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 means we can better plan care for a population. Advances in genomics are changing our thinking, from diagnosing and treating illness to predicting and preventing ill health. The development of precision medicine will increasingly allow a patient to be treated as an individual, not a number. An influx of new mobile and bio-devices will mean we will be able to check – and take greater control over – our health in a way never previously possible. These kinds of innovations will enable organisations to make better population and individual healthcare decisions.
All these big changes are under way. They will accelerate in the years to come. The question policymakers should focus on 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 do not emanate from the public side of health. They come from private players. For example, biopharmaceutical company AbbVie has launched Live:Lab (which, full disclosure, I chair), a collaborative, preventive health initiative, led by technology and designed to alleviate strain on the NHS by reaching out to people who are 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 the big tech players have placed large bets on the health sector. The future of healthcare will involve forging networks with the Googles, Apples, IBMs and Facebooks of the world, while maintaining strong relationships with the charity sector and not-for-profit organisations. Patient groups and voluntary organisations also have a key role to play giving a voice to the public and providing more responsive services.
The NHS needs to face outwards, to go with this tide of innovation, instead of seeking to stand in its way. The cyberattack on NHS trusts in May reinforced for many fears about advances in technology and the potential threat it poses to privacy. Of course, the right safeguards are needed, but 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 provided so that we improve outcomes, optimise resources and empower patients. That would ensure the NHS is able to outlive us all.
