A health service for the 21st Century
The NHS was born out of consensus: the agreement that healthcare should be free at the point of delivery to tackle society’s ills. 70 years on and the only consensus is that the system is in critical condition.
Since the creation of the National Health Service in 1948, the population size has increased by over a third, and the average life expectancy has risen by nearly two decades. Illnesses, fragility and immobility are much more common as one gets older, so a growing ageing population has brought enormous strain to a limited provision.
Together, the changing nature of modern day life and the de-stigmatisation of mental health problems has increased the demand for mental health services extraordinarily. Mind charity reports 1 in 4 in the UK citizen will experience such a problem each year. We should welcome this growing acceptance but question whether the health service is suitably equipped to treat it.
Siva Anandaciva, Chief Analyst at the King’s Fund healthcare think tank, recently gave a damning verdict. “Overall, the NHS does not have the level of resources it needs to do the job we all expect it to do, given our ageing and growing population,” adding, “and the OECD data confirms that.” This aligns seamlessly with almost every expert study and interview from the last few years; all except those from the government.
This is unsurprising. The NHS is an election-determining issue, and although the current crisis is not entirely the Conservatives’ fault, it harms their opinion polling simply to admit there is a problem on their watch.
Healthcare is too important and too precious to continue as a political football. So, the solution is an independent Governor of Health and Social Care – though perhaps with a more catchy title – who can make radical and difficult decisions without political interference or self-interest.
With a terms of reference from Parliament, outlining the purpose and objectives of a system fit for the 21st Century, a Governor should be appointed to lead a research-led and public-informed team. Their task will be to formulate a functional and sustainable model for health and social care. They will have the freedom to identify and resolve weaknesses in the current system or devise a total overhaul of the status quo. Nothing will be off the table.
The likely challenge to this proposal is the increased cost, but this fails to understand the premise of the change. We have absolutely no idea what this new system will cost, because we do not know what the Governor and their team will design as a system fit for 21st century Britain. I expect the terms or reference from Parliament will include ‘good value for money’ – or words to a similar effect – so it is not as if they will be given a blank cheque.
Governors will serve an 8 year term, although the majority of the inaugural Governor’s tenure will be spent designing and implementing a new way of doing things. From then on, they will be the chief executive of the health service, responsible and accountable for its activities.
Even 5 year prime ministerial terms are too short to formulate and implement major reform, as the present state of emergency requires. Instead, we see the Department of Health dictating countless targets to the service providers with sanctions for failure to achieve them. In reality, these financial sanctions can limit a hospital’s ability to improve; but at least the government can be perceived as taking action.
Reforming the NHS is expensive and time consuming. The Lansley reforms of 2012 further burdened a health service with heavy workloads and empty pockets. Already, some components have been overturned or replaced. Regardless of your view on these particular reforms, we can all agree that any major reform must be sustainable for the long-term and solution-focused. That is what the Governor will be asked and equipped to create.
And what if a sizeable minority do not like the Governor’s proposal? That is a likely scenario. The leadership – and posturing potential leadership – of the two main political parties is ideologically opposed, with no sign of relenting. In this environment, where no one has a strong majority to govern boldly, the best one can expect from the lawmakers is a plaster-fix over a gaping wound.
Politics is getting in the way of development. There may not be full consensus, but something urgently needs to be done. We need an innovative and informed transformation, or our health service is going to flatline.