Our health and social care services are not sustainable in their current form. The news that the NHS recorded its worst ever performance figures in January shows it is struggling to cope with unprecedented demand and missing waiting time targets as a result. Lack of community-based care means that hospitals are under increasing pressure. A&E services bear the brunt, bed-blocking stretches capacity and winter crises have become a regular fixture on our annual calendar.
Simply pouring more and more money into the system is no longer enough. A new report published this week by the New Local Government Network, Get Well Soon, argues that the NHS must construct a 15-year plan to shift the balance of funding out of hospitals and into investment in communities. Failing to do so risks an ever-deepening crisis.
The government has promised the NHS an extra £8bn a year by 2020, but this comes at the expense of spending on social care and public health. If we continue to simply prop up ever more pressurised services in the short term, we will never address the root causes of increased day-to-day operational pressures facing a system that is fundamentally unable to address the modern challenges it faces.
The good news for us as a society is that individual life expectancy is increasing. Today, people live an average of thirteen years longer than they did when the NHS was created in 1948. But, as more of us live longer, many of us do so with one or more long-term conditions that need ongoing management. And modern lifestyle diseases like obesity – inconceivable as an epidemic in the late 1940s, when rationing was still in place – have grown in prominence. Obesity alone is estimated to cost the NHS £5bn a year, causing knock-on health problems such as diabetes or high blood pressure, which need treatment.
These emerging health trends are piling pressure on a set of services that were set up primarily to treat illness in clinical settings. There is increasing recognition that only about 20% of individual health outcomes are the result of clinical treatment, with the remaining 80% influenced by wider factors such as lifestyle choices, the physical environment and social factors
As a result we need a system that provides the majority of support outside hospitals and that is much more focussed on preventing admissions in the first place. This would be not only better for us as individuals but also less costly for the public purse. When people do have a long-term condition, they need to be able to self-manage and receive care at home to remain independent. And all of us need to take responsibility for keeping well and preventing avoidable illnesses occurring in the first place.
But the current system is only designed to meet us by the time we have become a patient. There is a risk that lack of the right support early on creates more severe (and more costly) problems further down the line. This will encourage political pressure for more money to be found to prop up the crisis end of an unreformed system. This is a vicious cycle that we must break out of.
Rather than limping on to the end of the decade, the scale of the challenge requires a bolder approach to make sure our system is sustainable and fit for purpose for the future. The Place Based Health Commission calls for a 15-Year Forward View to set out a long-term plan for a reformed system of health and wellbeing, which focuses existing resources more effectively on prevention. This would mean moving towards single health and wellbeing budgets to align investment and rewards and new payment mechanisms that incentivise prevention rather than activity in hospitals. Building this plan needs to be taken out of short-term operational pressures and political cycles that can get in the way of a longer term focus on system transformation.
Moving beyond short-termism is a principle the government is committed to in other areas. The National Infrastructure Commission is doing just this for the long-term health of our economy – we need the same ambition for the wellbeing of our people.
A 15-Year Forward View would act as a blueprint to generate a vision of place-based health that works across all institutions, not just the NHS but local government, charities and housing providers, which currently largely work separately within a fragmented system. Bringing these organisations together would contribute their range of expertise and resources to deliver a reformed system that better influences wellbeing and engages people in their own health outcomes.
The NHS was designed to solve the health problems of a nation in the middle of the last century. To effectively tackle the challenges of the 21st century it needs to move from a service for sick people to a system that supports wellness – and that means reaching out so that everyone plays a greater part.
