The NHS is under threat. Only a new model of care will save it
The government’s refusal to embrace prevention rather than treatment as the way forward is putting Britain’s greatest post-war achievement in jeopardy
The NHS will celebrate its 70th birthday this year. Last month, Jeremy Hunt credited the Tory party for its formation. History tells a different story. The National Health Service was introduced in 1948 by Clement Attlee’s Labour government. The Conservatives consistently voted against it.
Before 1948, the have-nots feared ill health. Not for the reasons you or I fear it, but because they had no means to pay for treatment. Harry Leslie Smith has educated us all on how the fear of ill health gripped the poor before the creation of the NHS. The creation of a universal healthcare system, free at the point of use, was Britain’s greatest post-war achievement.
But the NHS made an error from the start: building services around treatment rather than prevention. We see the ramifications of this today. By seeking to treat ill health rather than tackling its causes, successive politicians have lost sight of the path to securing an affordable NHS.
Today, soaring levels of obesity and type 2 diabetes have strained the treatment model to breaking point. Moreover, too much unnecessary surgery and prescriptions of statins and antidepressants, for example, place avoidable strain on the service. Quick fixes are prioritised over the promotion of light exercise or a clampdown on junk food corporations. Poor town planning, weak infrastructure and poor quality housing fuel health problems that ultimately cost the NHS billions that it does not have.
Last year turned out to be the annus horribilis I predicted. There was a continuation of the poor strategic thinking that has dogged the NHS since 1980. Rising inflation rendered any extra money pledged by Phillip Hammond as futile, and NHS managers needed funding commitments earlier in the year so they could plan for this winter. But it came too little and late to make much difference. Thus, we are set for a repeat of what the Red Cross last year called a “humanitarian crisis”.
The NHS has entered the worst winter crisis of its 70-year history. A shortage of doctors, nurses, beds and care packages for elderly patients means that black alerts, trolleys in corridors and dangerous safety levels for patients are at a peak. NHS England has cancelled tens of thousands of hospital operations, which will create the biggest backlog in the health service’s history. A&E services are in a permanent state of chaos. What was once confined to winter is now an all-year-round occurrence.
Despite Hunt’s boasts, mental health services are still woefully underfunded. The closure of more than 4,000 mental health beds since 2010, and a similar reduction in the number of psychiatric nurses, have not been reversed. Hunt has yet to match his words with deeds.
GP services are also in a perilous state. A pledge to train more doctors in 2017 will not yield dividends in this parliament. GP vacancy rates and rural practice closures remain high. GPs spend taxpayers’ cash more efficiently than any other part of our NHS; more investment in the training of GPs and cash for surgeries would reduce pressure on the acute sector.
Social care services are in a state of paralysis. The £2bn pledged in the budget to reverse £5bn of cuts to social care funding is nothing more than a sticking plaster. The funds will do nothing to alleviate pressure on GP services and A&E departments. For now, we rely on the heroic efforts of six million unpaid carers to maintain a flailing social care system.
The fear of getting ill that gripped Britain in the past has returned. The principle of a universal healthcare system free at the point of use is broken. This government has ushered in a creeping reduction of universality, through the demonisation of ill people and the incremental rationing of care. Denying surgery to those who smoke or are obese is the thin end of the wedge; hip, knee and cataract surgery are all increasingly rationed and, in April, the NHS launched a consultation to end the provision of painkillers and basic vaccines. This would see a return to the pre-1948 system.
The NHS must move from a treatment model of care to one of prevention. Decisions made at the health service’s inception created the problems we see today. Social care was never integrated with the NHS, and domiciliary care has always been left to a mixture of private companies and local councils.
The NHS’s unique strength has always been that its large purchasing power and economy of scale make it more economically efficient than its international comparisons. But a lack of joined-up thinking fails to make the link between people aged over 75 presenting at A&E departments and cuts to social care funding. Our political discourse has not helped. Pressurising councils to freeze council tax at the height of austerity has compounded problems.
And how can Hunt’s performance in 2017 be rated? All the key indicators within the NHS worsened, with waiting lists reaching 10-year highs.
Hunt’s continued refusal to embrace prevention as the care model of the future is lamentable. History will record that he oversaw a massive increase in NHS cash being handed to non-NHS providers. Billions of pounds of health service funding have passed to non-NHS providers under the Tories. That sum will continue to grow.
We must prepare for another tough year for the NHS. Expect more lawsuits from private healthcare providers when they lose out on juicy contracts. Expect more uncertainty as the government equivocates on the importance of overseas healthcare professionals. Expect more privatisation, rationing and cuts to our health system. As long as Hunt remains in charge, expect warm words but little else.
Our NHS needs a new model of healthcare. It needs proper transparency and accountability. If politicians are to remain involved at the heart of the NHS, then it should be to ensure it gets the funding it needs, not to ready it for an insurance-based system.
Kailash Chand is honorary vice-president of the British Medical Association and has worked as a GP since 1983