The NHS celebrates its 66th birthday this week – a milestone overshadowed by serious questions about its long-term future.
When looking at the history of the NHS, it is difficult not to be amazed by the fact that it has managed to become one of this country’s most treasured institutions. It came into being in the aftermath of a devastating war that had left Britain facing financial ruin. The population at the time struggled from a variety of health challenges that had been worsened by piecemeal health provision in the decades before the NHS was launched.
The fact that the NHS survived those early years – let alone being created in the first place – is a testament to its founding principles that promised to deliver free accessible healthcare to all those who needed it.
But as it edges closer to its seventh decade, it faces a combination of pressures: some new, some old.
Resources and funding have always been an issue for the NHS, unsurprisingly given its size and scope. However, demographic change is seeing our society age and placing a strain on the NHS and particularly GP services. Already we have over ten million people over the age of 65, this will increase to 15 million by 2031. By the beginning of the next decade, a million people will be living with dementia and around the same time we will have close to three million with one or more chronic conditions. This shift would be a huge issue even if it didn’t come in an age of austerity where funding is being squeezed badly so that all parts of the NHS are under real pressure.
All of the challenges are intensified, however, by a political preferences for short-term gimmicks rather than long-term solutions. These problems need innovative, long term and sustained solutions, but sadly that is not what our political leaders are pursuing.
Recently, Jeremy Hunt’s proposals that GPs be ‘named and shamed’ when this miss cancer diagnoses was met with shock and horror by primary and secondary care doctors.
And while Labour’s 48-hour waiting time appealed to patients, the party’s own shadow health minster Jamie Reed admitted it wouldn’t be achievable unless GP numbers increased.
The Government’s controversial care.data scheme had to be delayed after outcry from the BMA and RCGP earlier this year, and surveys have since shown that over half the public are still in the dark about how their data is being sold off.
Meanwhile the Health and Social Care Act has insidiously placed competition into the health service, resulting in fragmented care and wasted resources.
Time to invest
GP facilities are in a worrying state of decline having been starved of investment for many years. Many GPs now have to deliver care in cramped conditions and are spending close to two-thirds of practice income on paying rising costs to maintain their premises. Other parts of the NHS are also suffering badly. Emergency care meanwhile is suffering from long running recruitment problems and like general practice, are finding it difficult to cope with the level of demand they are facing.
At such a crucial junction in the history of the NHS, we need to dispense with this short-term approach. And the public knows it. A recent BMA survey showed that three quarters of respondents believed that political parties are designing health policy to win votes, not to do what is best for the NHS.
Based on US experience, savings on market bureaucracy and commercial contracts could save billions, and fund more staff, better premises, and a better quality of care.
As the BMA’s ‘Your GP Cares’ campaign calls for, we need real investment in GP premises, services and staffing levels. And we need a comprehensive approach to the rest of the NHS too, which includes repealing the Health and Social Care Act.
But most importantly, we need all politicians stop meddling in a damaging pursuit of votes.
Dr Kailash Chand is the deputy chair of BMA Council and a former GP. You can follow him on Twitter @kailashchandOBE.
