The NHS at 100 - time to reimagine the future?

Last year we celebrated the 75th birthday of the NHS, its achievements, innovations, staff, and its ability to provide healthcare to millions of people free at the point of need. It’s testament to the model of healthcare that it has been unchanged, aside from advances in science, technologies, and medicine.

However, I often ask myself how long the current model will last and what we need to plan and deliver as we approach the 100th birthday. It’s a difficult conversation because we know the public have an enduring faith in the NHS and its founding principles, despite satisfaction struggling in recent years. 

The fact is, the NHS is struggling to keep up with consistently rising demand and endlessly squeezed resources. Our ageing population, coupled with a rise in chronic, long-term conditions and population health challenges such as obesity, smoking and drinking, means people are less healthy, in turn increasing demand on the NHS and social care services.

In Wales, Ministers have been open to having an honest conversation with the public about the future; about how we sustain services swift to react to ill health at a time when we need to redouble our focus on poor levels of public health

There are a number of key priorities for the Welsh NHS Confederation which require significant effort to reimagine what we do and how we do it.

Shift focus to community care and stabilise social care services

Social care has a crucial role to play in care pathways by enabling faster, safer hospital discharge and keeping people well for longer outside of hospital. Therefore, vulnerabilities in social care provision impact both demand on, and the capacity of, the NHS. Without appropriate resource for social care, including a sustainable workforce with pay parity with health, the NHS can’t improve patient flow through the system and make serious inroads into waiting lists.

We have an ageing population and evidence shows we’re due to have significantly more that need looking after over the next 20 years, with fewer people to do it. This affects both the health and care workforce and the general population. 

Over the past 75 years we have expected to receive more of our healthcare within a hospital environment. However, many people can be better cared for closer to home, especially when considering the developments in treatment and technology. We must enable local health systems to proportionately increase investment into primary care and community-based services, mental health and social care to allow for this shift

Capital investment

Capital investment is key to enabling the NHS to deliver high quality, safe health services and reaching longer-term goals to integrate care. 

12 per cent of the estate was built pre-1948 and only 6 per cent post-2015. Many of our NHS buildings are no longer fit for purpose and require millions of pounds in recurring maintenance costs, requiring significant investment achieve modern standards. 

We need a commitment from governments to increase long-term capital spending to reshape NHS estates and infrastructure, improving energy efficiency, patient experience and quality of care. There’s also an opportunity to rethink how we use our estate across the public sector, enhancing efficiency by delivering a more integrated service offer in our communities.

Workforce

The health and care workforce is at the heart of how we deliver care and the NHS is Wales’ biggest employer, currently directly employing around 110,000 people.

Despite growth in the NHS workforce, keeping up with demand has been increasingly difficult, with recruitment, retention and vacancy rates an ongoing issue. 

Maintaining and developing the current workforce is just as important as growing and training a new one. We need to continue to promote staff wellbeing, delivering agile and improved ways of working for staff and volunteers and plan for a sustainable and resilient workforce to better match changing demand and digitally delivered services.

Focus on the wider determinants of health to tackle inequalities and population health and wellbeing

The NHS doesn’t have all the levers to improve health, accounting for around 10-20% of a person’s health, with the rest impacted by socio-economic factors. Health inequalities cost the Welsh NHS an estimated £322 million every year, and in Wales we have a statutory duty to improve the health of the population.

We need drastic action to tackle existing population health challenges, which are projected to worsen in years to come. This includes obesity, smoking, excessive drinking and poor levels of physical activity. These cause largely preventable health issues and make up a huge proportion of demand on the service – more than we’ve ever seen before.

We must also address the wider determinants of health to achieve sustainable health and care services. Things like the economy, housing, planning policy, transport, education, food quality and climate change all have a huge impact on demand and the ability for the NHS to do its job. We mustn’t forget that a well-resourced NHS is vital to the running of the economy, including supporting people to work.

We need a strategy for national health that goes beyond the NHS. As part of this, governments should develop a cross-government, cross-sector strategy for health improvement to shift the focus from treating illness to promoting health and wellbeing, reducing inequalities and tackling the wider determinants of health, supporting the public to be active partners in their own health.

We must redouble efforts to think as One Public Service. All sectors have a role to play in creating a preventative model and collectively we need to create an environment in Wales that actively promotes and supports people to live healthy lives. 

Opportunities for innovation, creativity and focus

The history of the NHS is one of evolution, responding to the needs of the nation. The NHS continues to drive innovations in patient care, none of which would be possible without the skill, dedication and compassion of staff in the NHS, social care, third sector, volunteers, unpaid carers and communities that support the health and wellbeing of the nation. 

However, we must further capitalise on the potential of digital innovations. This will enable people to maintain their independence, health and wellbeing, stay up to date with the latest information relating to their care and access a wide range of health and care services from home. Digital innovations must be seen as enablers for patients and staff if we are to reform how we engage with people.

Investment in new medicines, research and digital will ensure we continue to live longer, manage our own health and wellbeing and lead healthier lives, and tackling digital exclusion will be key to ensuring everyone has the capability and skills to navigate and access services in this way.

Conclusion

Our health and care services are not sustainable in their current form and we need to act now to address key areas such as population health, workforce retention and recruitment, sustainable social care services and NHS estates as a priority.

So what do we want from an NHS fit for the future? A future where health and care is based on early detection and prevention, provision in the community by default and hospital admission for acute services only. A future with a whole-system approach, which focuses on wellbeing and delivers care at the right time and as close to home as possible.

But we must bring the public with us to realise this transformation. The public must feel personally invested in their wellbeing and our health and care service to help ensure its long-term sustainability, which will only be possible through public involvement and co-production of services. This will allow people to feel supported, empowered and informed to take more responsibility for their health and wellbeing, manage their conditions and use services responsibly.