The NHS turns 70 – a cause for celebration but also a note of caution

There have been many tributes to the NHS this week as it turns 70.  The National Health Service was established in 1948 to ensure that everyone in the UK could have access to proper healthcare, regardless of whether they had the funds to pay for it.  In the 70 years that have followed, millions of people have benefitted from free treatment and the NHS remains at the forefront of medicine; providing world class emergency care, cancer care and research and development, to name but a few.

The founding of the NHS was an astounding achievement and it is absolutely right to celebrate that and the fact that, 70 years on, treatment remains free at the point of delivery.  However, it is also a time to consider what the next 70 years might have in store for the NHS and whether it can survive without drastic change to its funding, structure and organisation.

What is clear is that the NHS is enormously stretched.  Medical staff are seeing more patients than ever with increasingly insufficient funding to meet the demand.  Thousands of nursing staff have felt forced to leave the NHS following years of frozen pay and poor working conditions.  Life expectancy has increased greatly over the last 70 years and many people are now living well into old age but often with complex medical conditions which need to be managed.  All of this is stretching the NHS to physical and financial breaking point and is impacting on the quality of patient care.

What can be done to safeguard the NHS for the next 70 years?  Years of funding cuts have meant that general practice and community services have been pared to the bone.  Patients regularly complain that they cannot secure an appointment with their GP which means that many will attend their local Accident & Emergency department instead, often with symptoms which would be better seen and treated in a primary care setting.  The increase in Accident & Emergency attendance during Winter 2017 had ramifications across the board.  Intolerable pressure was put on A&E staff and non-emergency operations and outpatient appointments were cancelled to ensure that staff were on hand to cover Accident & Emergency.

GPs operate an incredibly important frontline service; treating and managing the care of patients with both minor and more serious illnesses and conditions whilst referring on those patients who need specialist care.  The loss of district nurses in many communities has also resulted in increased pressure on Accident & Emergency and more patients struggling to cope at home with ongoing health problems.  Community services need to be invested in and restored to provide better patient care in the community and to relieve the pressure on our hospitals.

It is also clear that the funding and management of hospital Trusts needs to change.   Long term insufficient funding and poor management has led to huge financial deficits in some hospital Trusts requiring emergency top ups from the Government which only temporarily plug the gap.  The NHS needs to receive sufficient funding to enable it to provide and manage patient care without stretching staff and resources to breaking point.  The NHS has historically been funded through National Insurance contributions but it may be time to rethink how the funding is apportioned and/or whether a new or redefined tax or funding stream is needed.  Doctors, nurses and other medical staff providing the care and treatment should be consulted and given more input into how their hospital is run.  Too many decisions are made by managers who have little or no experience of patient care which ultimately leads to shortcomings in that care.

The issues of funding and management of the NHS are complicated but change is necessary to ensure that the NHS will be a cause for celebration in the next 70 years.

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