The words ‘crisis’ and ‘unprecedented’ are so often overused by the commentariat, yet a glance at history for longer than ten minutes will reveal that there usually is a precedent for something. This may not apply however to the huge challenges that the NHS is facing.
Rishi Sunak is correct to say that the pandemic has created additional pressures on the NHS, largely because fewer patients during 2020 and 2021 were able to have tests, operations and even undergo their regular health MOT that may have revealed a more malign condition that has only come to the surface now.
Yet the Conservatives, whilst forgetting that leadership requires taking responsibility and self-accountability, have become specialists in scapegoating. NHS woes: blame covid, inflation at 10.5%: blame Putin’s war, the economy teetering on the edge of recession: blame the global economic slowdown, backlogs swelling in our public services: blame the militant unions. This is a recipe for cowardice not leadership.
It’s a recipe that helps explain why the current NHS waiting list stands at 7.2 million people. The waiting list for mental health patients is almost 1.5 million people long. Judge a society by how it treats its most vulnerable and you will garner an understanding of whether you are living in a just society, one that is based on the premise that we each have duties and obligations to each other, or a market society, where the profit maximising and cost minimising rules of the free market have seeped into our sense of the collective. Surely our society must regain a sense of collective mission so that we can become a society of institutional builders and not institutional wreckers.
The NHS faces two types of problems. Short-run and long-run. The short-run is the mounting backlog and the delays in seeing a GP, having a test and an operation. It’s about the overflowing A&E departments and the wait for an ambulance. The long-run problem is even more challenging. Average life expectancy in the UK is now 80 years and so our population is living longer, but living longer with more chronic disease. Diabetes, Heart disease, Dementia and Arthritis are some of the most common chronic diseases that cast a looming shadow over our health system. To tackle both types of problems requires leaders who seek not to scapegoat, but who have the strategic vision and communicative ability to set clear objectives, define the measures that are necessary to achieve them and then have the courage of their convictions to carry out NHS reform. This is where politics becomes problem solving.
Surely our society must regain a sense of collective mission so that we can become a society of institutional builders and not institutional wreckers.
One of the great misunderstandings of British life is to underestimate the forces of conservatism that pervade not only establishment institutions like this university, but also our public services. Conservatism, meaning in this context hostility to reform and a preference for the status quo, exists on the left as well as the right, in the public as well as the private sector.
But how can the NHS stand still when the world around it is constantly changing? More older people, more chronic disease, a decline in mental health, new pressures created by the pandemic.
Given the demographic pressures on the NHS, it is inevitable that spending on health as a proportion of GDP will rise. Instead of the government being reactive and waiting for the demographic challenge to become so intolerable that it is like an explosive device wrapped under the NHS, before they announce a new funding settlement, why doesn’t the government show some strategic vision? The new funding settlement should include a rise in national insurance contributions for employees and employers and a dedicated levy to finance a national social care system that is fully integrated into the NHS, so that ‘bed blocking’ becomes a relic of the past. Leaders need to be truthful; if people want public services of Nordic quality, they cannot expect to pay American levels of tax. If we want sustainable, resilient public services that don’t buckle under pressures every winter, then tax as a proportion of GDP must rise. The idea that through a little bit of tinkering with the bureaucratic structures of the NHS and some efficiency savings we are going to eradicate a 7.2 million long waiting list is wishful thinking on steroids.
But it’s not just about money. Under-staffing is a great challenge and once again the solution lies in an uncomfortable truth for some. Immigration is part of the solution to the problem instead of the problem being immigration creating additional pressures on the NHS. There are over 100000 vacancies in the NHS and the vacancy rate for the adult social care sector is 10%. The problem is that there are not enough people in the UK who currently live here who want to go through the several years of expensive training to work in the NHS to become a doctor, consultant or GP. So that means that the only solution is to welcome more high-quality medical professionals from abroad who want to work in our NHS.
The other vast challenge we face is our poor public health. Our mental and physical wellbeing as a society is too low. For too many, processed food has become a staple of their diet, alcohol and drug dependency is rampant, mental health conditions such as anxiety and depression aren’t identified early enough and are left to fester, for too many exercise is seen as a last-resort as opposed to the first line of defence against ill health, sugar has become the new cocaine.
Prevention is always better than the cure and so the single best way to reduce the pressures on the NHS is to build the world’s healthiest population and that must be our mission. The ‘daily mile,’ the activity of walking/running a mile during school, meditation lessons, P.E. lessons not twice a week but four times a week in school and new cycle highways and nature parks to encourage the embrace of the fresh air should become part of the solution. This is not about the state acting as the moral police, but it’s about the state collaborating to create a more mindful and mobile society.
The NHS is stuck in an unforgiving cycle of crisis and then a sticking plaster solution, crisis and then a sticking plaster solution. But plasters can’t hold forever. Only courage and strategic vision will help rebuild the NHS and make it fit for the future.