by Karen Taylor, Director, Centre for Health Solutions
As almost everyone knows, the Fourth of July is American Independence day. My premise for this blog is that the 5th July 1948, which marked the birth of the NHS, was in fact the day that people across the UK were liberated from worry and distress over their own health care. Consequently, a fitting tribute to the NHS on its 70th birthday would be to declare 5 July as our own ‘independence day’, and fight with all our might to retain the principles and values of the NHS.
The NHS’s creation was an explicit rejection of the unfair rationing of health care where people who could not afford it would go without or rely on charity to afford treatment. Today, as the NHS celebrates its 70th birthday, it continues to enjoy huge support, with the majority of the public continuing to see the NHS as a ‘national treasure’ that defines the way we value health at both an individual and a societal level. The NHS also has a set of values designed to ensure we deal fairly with the risk and uncertainty of ill health. It also provides assurance to all on how the state will protect its citizens.
Today, the NHS provides a variety of care much more efficiently and to more people than in the past. Care is also more evidence-based, less paternalistic, and more efficient and effective. It is also much more cost-effective than many other comparable health care systems. Technological developments such as safer anaesthesia and laparoscopic surgery, modern maternity, obstetric and end-of-life care, and significant advances in life-extending and precision therapies are improving health outcomes. Many people who experience a stroke, coronary heart attack or cancer are alive today who would not have survived 10 years ago. The majority of people who have had a child with a life threatening or life limiting illness will attest to a health service that goes above and beyond all expectations, providing care to the child and support to the family in equal measures.
According to the OECD’s latest country profiles in its State of Health in the EU, life expectancy at birth in the UK was 81 years in 2015, up from 78 years in 2000 and above the EU average. Spending per head is above the EU average, and the share of GDP spent on health (9.9 per cent) matches the EU average in 2015. Public funding provides 80 per cent of total health expenditure, and out-of-pocket payments, as a share of household consumption, ranks third lowest in the EU. Overall, amenable mortality in the UK is better than the EU average and, importantly, unmet needs for medical care are low, and coverage is highly equitable, with very narrow differences in access to care between high and low income groups.1
Nevertheless, performance statistics show that the last few years have been increasingly tough with little sign of a let up. In the face of unrelenting demand, the waiting times and other performance targets introduced during the 2000s have proved too challenging for most NHS trusts, with only five major A&E departments meeting the four-hour A&E target in 2017-18. An increasing number of people waited longer than four hours on trolleys for admission to hospital, and overall performance against the four-hour target dropped to the lowest levels seen in 15 years. Nevertheless, the NHS continues to work heroically to stay afloat, taking drastic steps to manage demand for urgent care, such as deferring planned elective treatment and increasing its focus on demand management, referral protocols and improving the management of delayed discharges.
While we should indeed celebrate the NHS, we also need to spare a thought for social care and that in the same year that the NHS Act was passed so was the National Assistance Act 1948 (13 May 1948). This latter Act established the National Assistance scheme to provide support to elderly people who required supplementary benefits for living. It also obliged local authorities to provide suitable accommodation for those who through infirmity, age, or other reasons were in need of care and attention not otherwise available. Those who could afford it, could be charged to cover the costs of their accommodation or the care services provided, unless they could satisfy the local authority that they had insufficient means to pay.2
Today, the plight of social care has become a national crisis, with most local authorities raising the bar on eligibility criteria, requiring families and millions of unpaid carers to fill the gap left by the lack of local government funding. Indeed, over 900,000 people who used to benefit from social care no longer do so since local authorities raised the eligibility bar.
Deloitte’s public sector survey for our State of the State in 2017 report showed most people were unclear what social care is and even less clear on how it is funded.3 This also provides part of the explanation as to why the public have not been more vocal about the parlous state of social care. Let’s hope the increased emphasis on integrated care, the emergence of new models of care and the expectations of the new white paper will provide a belated birthday present for social care.4 This is just as important to the NHS, as numerous studies have shown that the absence of effective social care is inexorably linked to the increase in demand for health care.
So back to the NHS and the celebration of the 70th birthday. While the NHS is far from perfect, our 2016 report, Vital Signs, found there isn’t a healthcare system in Europe or anywhere else in the world that is.5 Those contemplating alternatives should be careful what they wish for, as despite eight years of flat-line funding, the NHS is out performing the UK economy. It continues to treat millions of people successfully day in and day out and regularly performs miracles without causing the people who need it unwarranted financial hardship. Moreover, no other country is as transparent in measuring and reporting the quality of performance.
It has been 10 years since we celebrated the NHS’s 60th birthday – when funding was more plentiful and most commentators on the NHS were extremely positive about its future. Few were aware of the economic downturn that was just around the corner or the unprecedented challenges that the NHS would face. Despite the challenges, the NHS has survived and in many cases has thrived and something we should be extremely proud of. It is also something I’ve seen first-hand over the past seven and a half years as a non-executive director of an NHS trust where, despite the challenges, patient outcomes and feedback from staff and patients alike remains extremely positive. So, as I intimated at the beginning, we should indeed celebrate the NHS as it turns 70 and remember how it has provided us and our families with an independence from worry and financial despair.
Happy 70th Birthday dear NHS, happy birthday to you - and many more!