The future of our NHS – Reasons to be fearful 1, 2,……..10!

B6s3N2sIMAEU2GLEvents of the last couple of weeks can leave nobody in much doubt that the NHS is struggling this winter. But does this signal the death of the NHS, as the tabloid press is spinning it, or is it just a temporary blip as the government would have us believe?

The answer lies, as always, somewhere between the two but I believe that a perfect storm is brewing. We require urgent and decisive action or we will see the end of the NHS as we know it before the end of the next parliament – regardless of who wins in May.

The NHS is part of the fabric of our nation and the vast majority of the public have not yet accepted the message that its future is really under threat. After all it is among the most efficient and effective healthcare systems in the world. How could we possible let it go?

This series of 3 blogs is written for the large section of the public who to date have had relatively little information about the issues, but it should also be of interest to those with a greater depth of knowledge. I hope to persuade you that there is a clear and present danger. I you disagree with me on any point please leave a comment at the end. If you think I am wrong you must say so. If you agree you should share the links.

In the first of three linked articles I will outline 10 significant threats to the service.  In the second I will suggest where we are heading if no action is taken. The final blog will cover what I think we could do to improve things and give you an opportunity to share your ideas.

Reasons to be fearful

  • An aging population – We are all living longer. The average life expectancy goes up every year. Sadly much of this extra life time is spend in declining health so our need for health services increases even more.
  • The obesity epidemic – Obesity rates are rising rapidly. Currently 25% of us are obese and this is expected to rise to 50% by 2050. Obesity is associated with high blood pressure, heart disease, diabetes, stroke, arthritis cancer and depression plus many other conditions which require health care.
  • B47J7foCEAAQvp_Increasing public expectations – There is an almost limitless amount of potential demand for health services. People can chose to treat themselves or ask for help from a variety of services ranging from pharmacists to hospital consultants. More are choosing to ask for help and are likely to choose the highest qualified. This is particularly noticeable in patients who are coming to the end of their lives. In the past it was often considered most appropriate for GPs to treat them at home. Indeed this may be the kindest approach in many instances. Nowadays it is increasingly common for people nearing the end of their lives to be sent to hospital for care.
  • Struggling social services – social care budgets have been cut by up to 40% over the last few years despite the increasing needs of an aging population. When social care fails people turn to the NHS in times of need. Hospitals are always open and will fill with people who really don’t need health care have reached a crisis and have nowhere else to turn.
  • New and expensive therapies – Cancer drugs, proton beam scalpels and robotic surgery all hit the headlines but every day hundreds of new treatments are launched which are slightly better and significantly more expensive that the old ones. The public expect access to the best but it creates huge healthcare cost inflation.
  • Fixed or shrinking budgets – Whatever the government says, real NHS budgets have been falling since 2012 and are forecast to continue to do so.
  • A negative press – the NHS frequently gets undeserved negative press coverage. I have written about this elsewhere. Suffice to say that it could undermine its reputation in the eyes of the public, which will make it harder to obtain the political support for necessary reforms.
  • Poor staff morale and recruitment – increasing work in the face of decreasing cash and a hostile press make it harder to recruit. We now rely heavily on staff trained overseas, but this valuable resource will not keep us going forever.
  • Privatisation – changes in the law (TTIP and the Health and Social Care act) that will encourage private companies to take over part of the NHS are coming into force. Private companies will inevitably cherry pick the easy and profitable parts of the service, putting the remaining section under increased pressure.
  • Lack of political will. The NHS is a problem for all political parties. It requires investment and reform. No party seems to have the appetite to make the difficult decisions about tax and public consultation that are so desperately needed. Letting it fail will get them off the hook. As we approach another election the main parties will expend a lot of energy talking about the NHS while becoming increasing incapable of taking any meaningful action. This at a time when the service will be under most pressure and likely to need decisive management.

So I hope that you are convinced there are difficult times ahead. If nothing is done there is a danger we will drift into a more fragmented hybrid public/private service with insurance top ups and will lose the core values of the NHS.  Care will be less efficient, inequitable and being ill will become a financial as well as a physical problem for many. More of this on part 2 of this series.

If you agree with these points then please share this post with others. If you disagree then say so in the comments box below.

Part two in this series of three and be found here.

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20 comments

  1. I read the WHO report a couple of years on the costs of ageing to the world’s health services. Their conclusions were ambiguous.

    However the Nuffield has done recent research in the UK and the evidence contradicts the received wisdom that the ageing population is increasingly costly:

    http://www.phc.ox.ac.uk/news/elderly-nhs-burden-2018smaller-than-thought2019

    “Hospital beds days occupied by persons over 65 fell by 9-10% in the decade to 2012/13, despite the larger numbers of older persons… “The perception that elderly people are placing an increasing burden on the hospital system needs to be moderated by a realisation that at each age people are a little bit healthier than they were in previous years and less demanding of hospital admission.”

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  2. I agree with some points however I think we all rely too much on NHS England and so many people do not do enough to keep out of the situation whereby a small problem easily solved by a pharmacist could prevent visiting gp’s or A and E. We need to get people respecting our NHS more and use it sensibly not as a crutch for everything. Much more could be done along these lines to ease the burden. We all expect too much from our NHS and think it is an economical bottomless pit as far as finances go.

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    1. Anita, how much less could the NHS cost? It is not overburdened by excessive demand. It has been cut to the bone. It should have grown in line with the growth of population. Instead it has shrunk. It costs us less, as a percentage of GDP, than any other country in the G7. There is scant evidence of patients dreaming up ever more excessive demands on the health service. Health provision is not a consumer product that we all want more and more of. The current crisis is A&E is not because of too many people, it is because of too reduced a service. There are fewer people attending A&E now than there were last summer. Last summer most hospitals met their targets. Now they can’t.

      The privatisers have used two arguments over and over again, since the early 1950’s – a scant 5 years after the birth of the NHS. The first is that the system will never be able to cope with the increasing numbers of elderly. And the second is that if you give people a service for free they will abuse and overuse it. It looks as though the public is finally more willing to repeat these arguments than to fight to save their health service.

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  3. All of this isn’t an accident. The privatisation has been a step by step plan. It’s about 80% complete. This is an analysis of the past 30 years of changes and what it ultimately leads to.
    http://legal-aware.org/wp-content/uploads/2013/01/Privatisation-discussion-final.pdf

    The bill proposed by Alison Pollock and Peter Rodderick would sweep away all the privatisation over the past 30 years and return it to a simple, accountable structure. The internal market alone costs billions a year. Some estimates put it at £10bn, possibly more.

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  4. I agree with all your points, but I think your missing a big one.

    With the ever increasing population, and the housing development in areas where it has seen its population double in a short period of time, at no point has the NHS been allowed to expand to ensure it can meet its patients needs. You are able to see it across the board with GP surgerys, schools, council services, where they are push to provide for their local population for a system thay was designed to deal with a smaller number than the quick rise seen in recent years. More needs to be done when huge developments take place, to ensure that investment is put into the infrastruce to suplort the people it is bring in.
    Because we dont currently have this, and the government are pushing for savings the pot to cover our growing population isnt growning with us but shrinking each year significantly…therefore stopping hospitals on increasing staff, extending to ensure bigger venues with more beds and up to date equipment….this would reduce waiting, alot of the bad press which quite frankly i would to see them stand behind the NHS and write good news stories for a month. You would see a knock on affect with the public, and therefore a knock on affect with staff.

    I work for the NHS, and I have had good and bad experiences as a user.BUT, i appreciate the fact that i have a free service which i can use, i appreciate that the nurse or doctor dealing with me has probably been on shift for 10 hours already and has probably had a rollercoaster day of abuse, losing patients, not had a break, and is bloody tired. We need to start appreciating what we have, because if we lose the NHS it will be too late when we realise after what a diamond of a service we let be chucked away.

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  5. I have worked for 27 years at the hard edge of the NHS and in the last ten years seen the number of medical beds cut and wards closed year after year. When I first started nursing at my local hospital we had 14 medical and elderly care wards, elderly care wards were then scrapped and all became general medical wards. We now have two general medical wards, an admissions unit, one rehab ward and a discharge ward to replace them. Two years ago I was working on a short stay medical ward that was closed, that attended more than 200 patients a month, bed pressures where at there highest levels ever, yet still they closed the ward. Apparently they closed because hospitals are no longer needed and care services are supposed to all now be available at home, or in the community. Vast funding was given to GP, s etc. Yet time and time again we hear every single day of patients who cannot access the care they need so arrive at hospital. The number of community facilities that we can discharge patients to has greatly reduced and respite care is barely none existent, so all these poeple who apparently did not need hospital care are now sitting waiting for care places to be found in the few general medical beds that we have, so that when an acutely ill person requires urgent treatment there are no beds for them.

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  6. There is reason to be fearful. The NHS is vitally important, as you say there is nothing else like it. The artificial market is costly and not working as you say and the press like to publish the bad stuff not just NHS but news generally. The NHS needed to create it s own “marketing” making sure the good news reaches their local population. It is important that all aspects of the NHS strive for excellence and staff and patient satisfaction. Also to work on those strategies that could replace the current artificial market through genuine integrated care.

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  7. On the whole I agree Steve.

    However I disagree personally with the “More [patients] are choosing to ask for help and are likely to choose the highest qualified. This is particularly noticeable in patients who are coming to the end of their lives. In the past it was often considered most appropriate for GPs to treat them at home. Indeed this may be the kindest approach in many instances. Nowadays it is increasingly common for people nearing the end of their lives to be sent to hospital for care.”

    Certainly the EoL patients I have cared for over many years we have kept the majority within their home environment. You will always get those who want to die in hospital or families that can’t cope towards the very end.

    The patients I have had the privilege to care for at the end of their life have had fantastic care and support from a wide number of specialist nursing teams with very little medical input.

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  8. The NHS is broken but not beyond repair. If Whitehall stopped trying to cost improve save money and invest we wouldn’t have the issues we have. Monitor CQC need to go and quality needs to be driven by those that provide the care. Inspection dosnt equal quality and wastes resources. Integration between social and health care will reduce duplication and fragmentation of services integrating health is the way forward. However with an ageing population an epidemic in obesity and poor social health the health service is now providing care for more chronic long term conditions. This is something the NHS was never set up to deal with. Things need to change and acute services need to be for acute care and community services need to embrace more hospital at home care. Privatisation will only bleed resources at extortionate cost and will fall foul of a commercialised health service. I believe that Ni contributions should be increased with designated funding to the NHS.

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