Radical long-term NHS reform is needed to fix the health and social care crisis
There are no quick and easy solutions to the health and care crisis. Important short-term actions are being taken but strategic longer-term reforms are also needed as well as clarity about the vision for the future.
These short-term actions including surgical hubs, improved discharge arrangements and innovative use of technology will make a difference. However, staffing issues also need to be addressed with a negotiated end to the current strikes and firm commitments made for improved pay and conditions for care staff outside the NHS.
These actions are necessary and will lead to improvements, but they are not sufficient. Longer term strategic actions which change the way the system works are needed. I only have space to mention two here, others such as drug development, science and technology are also fundamentally important.
We need a vision for the future of our health and care system which is about building a healthy and health-creating society
Firstly, priority needs to be given to investment in primary, community and social care in order to accelerate the transformation of the health and care system, from an institution-centred and illness-based system to a community-centred and health-based one. Hospitals are overloaded due to difficulty in discharging patients but also because too many people are admitted who could be managed at home with the right resources.
This is not just about capacity. The NHS is still essentially organised to provide for the health needs of the mid-20th century. Most pressure on the service today comes from older people with multiple long-term conditions who are not well served by a system based on hospitals, professional control and specialist demarcations. They need multidisciplinary team-based care which involves individuals, their family and carers and addresses all their mental, social and physical needs. Most of this care is best provided at home or in the community. The current organisation and financial systems make this very difficult and highly inefficient.
This is a radical change which will require, among other things, changes in professional education and the creation of a well-structured care system. It will be facilitated by AI and other technology helping coordinate care, monitor people at home and predict when they need interventions.
Secondly, about 70 per cent of health problems arise from social and environmental factors so the NHS has to deal with problems such as obesity, addictions, stress, diabetes and the consequences of inequalities, poverty, air pollution, social isolation, poor housing, crime, and poor nutrition over which it has little or no control. Good health services are vital, but policy on housing, education and other areas needs to promote health, safety and wellbeing and contribute to the health and prosperity of the country. The health of the population underpins the productivity of the workforce, attainment in education, impacts on crime and much more.
Against this background, we need a vision for the future of our health and care system which is about building a healthy and health-creating society – a vision that goes beyond high-quality health services and the prevention of disease, vitally important as these are, to involve creating the conditions for people to be healthy and helping them and the country thrive. Unless this happens, we will have continuing health and care crises.
It is easy for parliamentarians, like me, to express our views when we don’t have to implement them. In 2000 the government committed funding to improve the NHS and brought together NHS leaders and partners to create a shared NHS plan. The changes were largely owned by the people who had to implement them, and the goodwill created helped ease through many difficult and controversial decisions. It also led to what were probably the most rapid improvements in the history of the NHS.
Waiting lists fell to under one million in 2005, 95 per cent of A&E patients waiting times were under four hours in 2004, and remarkably, the use of the private sector by people who could afford it began to fall in 2003. The public knew things were improving.
Lord Crisp, former chief executive of the NHS.
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