The first thing to say is that survey data suggests that public satisfaction with the NHS is still pretty high. We work with the British Social Attitudes survey, which last year found that in 2015 overall public satisfaction with the NHS was 60 per cent, although this had fallen by 5 percentage points since the previous year. A poll by Ipsos MORI last year found that only a minority think that NHS services have got worse over the past nine years and a quarter of the public think they have improved. And in international surveys we tend to do quite well: a 2014 survey by the Commonwealth Fund ranked health care services in the UK first out of 11 countries.
However, there’s no denying that the NHS is currently under huge pressure. We’re all aware that it is treating more patients than ever before and as a result is struggling to maintain standards of care such as A&E waiting-time targets, which are at their worst level in over a decade. Financially, the system is struggling: NHS providers ended the financial year 2015/16 with a deficit of £2.45 billion, the largest deficit in NHS history.
“The government needs to choose between finding extra money for health and being honest with the public about what will happen if they don’t.”
But are the problems in the NHS all about money? Some of the pressures faced by hospitals, such as struggling to meet rising demand and waiting times standards, could be reduced if the government were to provide more resources. Funding has not kept pace with demand and since 2010 budget increases have fallen significantly. The government needs to choose between finding extra money for health and being honest with the public about what will happen if they don’t. In the longer term, we need to agree a new settlement for health and social care that would go beyond short-term solutions that keep the system just above water. That would involve moving to an integrated system for health and social care with a single commissioner of health and social care services.
Funding is not the only issue, however. Regardless of the current funding pressures, the NHS needs to change, and quite radically. An ageing population, with an increasing number of people living with long-term conditions such as diabetes, raises major questions about how health services need to be organised and delivered. The historic separation between GPs and hospital specialists, for example, and between health and social care services, gets in the way of delivering the best care.
In addition, differences need to be addressed in the quality of care that people receive depending on which hospital or GP surgery they’re treated in or which part of the country they live in. Identifying and then tackling overtreatment in some areas as well as undertreatment in others offers significant opportunities to reduce waste to improve outcomes.
It’s also clear that, compared to the rest of society, the health service has been relatively slow to adapt to new technology. We can see what the future might look like when we look at services that have been quicker to embrace technological advances, such as banks and shops.
The health system also needs to involve people in their own care much more, by giving them the information and support to manage their medical conditions independently so that they can be empowered to live healthier lives. Linked to this, there needs to be much greater priority given to public health and prevention, ideally through partnerships with local government, looking at the wider determinants of health such as housing and unemployment and location, with the aim of engaging people in their healthcare and supporting them to stay well for as long as possible.
“Compared to the rest of society, the health service has been slow to adapt to new technology. We can see what the future might look like in services that have been quicker to embrace technological advances, such as banks and shops.”
The NHS already recognises it needs to radically transform services and is trying to deliver change through what are called sustainability and transformation plans. But – and this takes us back to the money – funding is in such short supply that it’s difficult for services to find the headroom to make the changes that are so necessary. At the moment, bed occupancy rates in hospitals are hovering at around 95 per cent. This creates high-stress situations in hospitals which are disruptive for patients and difficult for staff, as well as having a knock-on impact on the rest of the health and care system. And when the system is under so much pressure, the focus is on keeping services going rather than on transformative change. It’s a Catch 22.