Yesterday, the NHS turned 72 years old – long live the NHS. It was interesting to watch Sir Simon Stevens on the Andrew Marr show, identifying the faults in the NHS shown by Covid-19.
Broken social care
Covid-19 has exposed the UK’s battered social care system. For over a generation, reform and renewal of social care have been shamelessly overlooked by politicians to the detriment of older people. Despite there having been 12 white papers, green papers and commissions since 1999, the one determining factor has been the absence of political will.
So what’s the solution? Social care and the health service will have to be better integrated. After all, we now have one minister responsible for both, if only in name. Any feasible solution will involve a mix of public, voluntary and private provision, coupled with public funding through higher taxes, or a small levy on all estates – say 10% to 15%.
General taxation and housing wealth, on the lines proposed by Andy Burnham when he was health secretary, are the right ways ahead. This approach would align social care with the NHS principle (free at point of use and based on need, not the ability to pay). This is also the right direction of travel for social and health care integration. Can Simon Stevens convince his political masters to follow this route and solve this crisis once for all?
Neglect of prevention, diet and lifestyle on health
The NHS made an error from the start – building services around treatment, rather than prevention. We see the ramifications of this today in the pandemic.
One of biggest risk factors for Covid fatalities are obesity and type 2 diabetes. By seeking to treat ill health rather than tackling its causes, successive politicians have lost sight of the path to securing an affordable NHS. Quick fixes are prioritised over the promotion of light exercise or a clamp-down on junk food corporations.
We’re seeing the ramifications of the NHS building services around treatment, rather than prevention
Poor town planning, weak infrastructure and poor quality housing fuel health problems that ultimately cost the NHS billions that it doesn’t have. How Simon changes the narrative from disease-focused healthcare to prevention would be test of his leadership.
A poor attitude to the BAME community
Right from the birth of the NHS in 1948, thousands of doctors and nurses immigrated from India, Pakistan, Bangladesh, Sri Lanka and African-Caribbean countries during the 1950s, 60s and 70s, recruited by a health service afflicted by an acute post-war shortage of healthcare staff. The NHS, without immigrant staff, would come to a standstill. They have worked in deprived and Cinderella services, and helped to achieve the sacred unique universal healthcare to the UK population.
Despite decades of evidence of disparities in health outcomes related to ethnicity and differential attainment among clinical staff, there has been little action.The appalling recent events in the US and the inequalities revealed by Covid-19 have shone a light on racism and the treatment of BAME communities.
All accept that racism in the health service is unacceptable. The evidence is clear on the discrimination and prejudice against patients and staff from ethnic minorities’ background. But my experience tells me the appetite of health systems in the UK to tackle age-old health inequalities based on race and ethnicity is nothing more than tokenism. It’s a tragedy that is understood, tolerated, and paid lip service, but it cannot be allowed to continue.
Sir Simon Stevens told me after the Marr interview that the above would be his top priorities. I wish him best of luck in his mission and offer my full cooperation in any genuine endeavour. But what we don’t want is more enquiries, more paper policy and more committees for an age old problem. We want action.
Dr Kailash Chand OBE is a retired GP in Tameside