Crisis what Crisis? The National Health Service, notions of health resilience and the 2015 General Election
With the UK Election drawing to a close the future of the National Health Service remains centre stage. With talk of a system in crisis the political rhetoric has been turned up to eleven, with accusation and counter accusation flying across the political divide. Little wonder given that the latest Ipsos Mori poll finds the NHS to be one of the most important issues for the British electorate, particularly for undecided voters . Is talk of a crisis correct and if evidence does point to a system in peril are politicians using their current electoral platform to forward sustainable solutions, solutions that incorporate for instance emerging thinking on the development of community and individual health resilience?
Top of the roll supporting the crisis hypothesis has been the recent failure to meet key performance indicators such as the target to admit or discharge at least 95% of all patients attending hospital emergency services within four hours . To this is added recent evidence of GPs delivering family medicine fatigued and quitting in droves. Then there is the NHS Chief Executive Simon Stevens recent contention there will be “a mismatch between resources and patient needs of nearly £30bn a year by 2020/21″ . The critics appear vindicated in their assertions and international comparisons don’t come to the rescue, with the most recent Euro Health Consumer Index placing the NHS firmly in the middle of the European health system league, just behind Portugal but ahead of Macedonia .
This is then an issue of money, but it is more than that. It is commonly acknowledged that the structure and nature of need for healthcare is rapidly changing as we increasingly move from acute to chronic care and in doing so see demand in sectors such as elder care increasing exponentially. At the same time pharma and med tech continue to bring new products to a market hungry for innovation. No wonder then that the health care inflation continues to hover around the ten percent level . Yet the holy grail of delivering sustainable healthcare appears as distant as ever, resembling more a canoe rowing into a tsunami than a cruise liner being steered towards calmer waters.
That having been said the NHS appears to be ahead of many other health systems in having the advantage of low transactional costs and being better structured than other health systems to avoid service duplication. The NHS has also maintained general or family practice as the primary gateway for care, which can again reduce pressures for unnecessarily referrals, whilst centralized controls allow for a more uniform approach and use of common policy levers. However, the NHS also retains a fundamental air of paternalism with the notion of the state providing care from ‘cradle to grave’ and politicians have done little to disavow voters of the notion that only they have hold of the levers that can make the real difference.
This then suggests that there is a cultural as well as a structural challenge facing the NHS. On this basis increased funding alongside the restructuring of services and the realigning of commissioning practice would be necessary first steps but would not be sufficient to achieve the scale of change required to deliver long term health service sustainability. Such change would only be achievable by additionally transferring a level of responsibility from the government and the NHS to individuals and the communities in which they live, which could help break the paternalistic trance and release energies and capacities for preventative and self care, which must form the cornerstone of long term healthcare sustainability. Unfortunately it does not currently appear to be that the appetite for such a new national health partnership exists and the current election campaign has done precious little to change this situation.