The National Health Service (NHS) is sometimes dubbed a ‘religion’ in the UK, with voters regularly citing it as one of their top concerns in deciding how they will vote during election cycles. Free healthcare at the point of use is recognized by citizens as something to be cherished and the UK’s public healthcare system is often pointed to by other nations (especially those with eye-watering private healthcare costs) as the gold standard for how healthcare should be delivered.
And yes, while citizens pay for the NHS through taxes , these taxes are charged on a ‘how much you earn’ basis - and being able to call an ambulance, or have a baby, or live with a chronic medical condition without fear of how you will pay for your medical bill, no matter how much money you have in the bank, is truly a huge benefit to living in this part of the world.
However, in recent years the NHS has come under immense strain. Part of that is down to the ongoing impact of the COVID-19 pandemic, which not only placed a massive burden on healthcare workers and hospital capacity during its peak, but continues to put the system under pressure. But that’s not the only pain point.
Experts and researchers point to how the demographics of the United Kingdom have changed compared to two or three decades ago, where the concentration of people who are living longer is significantly higher now (and will be more so in a decade’s time) than it was in the mid 1990s. That’s a win for healthcare in itself, or more broadly for the standards of living we experience now, but it’s worrying news for a healthcare system that was designed and is being funded for a very different population.
The two graphs below use data from the Office for National Statistics (ONS) which show how the UK is living longer, comparing the age of citizens between 1997 and a projected forecast in 1937. It’s not hard to understand this shift will place an increased demand on healthcare needs.
Not only this, but the population size has increased by more than 10 million people since the 1970s.
In addition to a brutal pandemic and an aging population, the NHS is also struggling to attract and retain talent. Figures towards the end of last year had vacancies standing at approximately 130,000 across the NHS, with even greater shortages (165,000) in social care. Recent and ongoing industrial action in the sector also indicates the level of satisfaction amongst workers in the NHS, with numerous reports that the healthcare workers we clapped for every week during the worst of COVID-19 are struggling to pay their bills and are having to resort to using food banks.
Couple this with the result of the Brexit vote, which has seen the number of EU healthcare workers decline in the thousands as a result of new immigration rules, increased bureaucracy and higher costs, and it becomes clear that workforce management is also a key challenge for the NHS.
But what can be said about funding? Isn’t it true that funding has actually increased in real terms in recent years? Planned spending for the Department of Health and Social Care in England is £180.2 billion in 2022/23. So it is indeed projected to increase by 1.2 per cent in real terms on average over the next two years.
However, this small increase follows a -0.07% average change in per capita healthcare spend between 2010 to 2015 and a -0.03% change between 2015 and 2021. For comparison, between 1997 and 2010 average annual change in per capita healthcare spend increased by 5.67%, which suggests that the current funding is still low compared to recent historical averages.
It’s also worth noting that the average day-to-day health spending in the UK between 2010 and 2019 (£3,005 per person) was 18% below the EU14 average of £3,655. Matching spending per head to France or Germany would have led to an additional £40 billion and £73 billion (21% to 39% increase respectively) of total health spending each year in the UK, according to research.
A complex problem
The point attempting to be made here is that there are a myriad of interwoven problems that challenge the future success of the NHS, which, unfortunately, are often reduced to sound bites on the political stage.
For instance, just in the past week we have seen how these issues present in the form of political solutions that amount to ‘we should pay for certain services at the point of use’. Former Health Secretary Sajid Javid wrote an opinion piece in the time where he called ‘grown up conversation’ about how the present model for the NHS is unsustainable and how the UK should consider a model whereby citizens pay for GP appointments and A&E visits, on a mean-tested basis.
Critics have argued that the government’s handling of the NHS over the past decade would lead to privatization models for the healthcare sector, claiming that the goal has always been to undermine the organization. It’s interesting that this is where the conversation is now heading.
However, that’s not the only discussion being had. Whenever the future of the NHS is considered, the topic of technology and how it can fix the whole system is also always brought to the fore. Just this past weekend the chairman of AstraZeneca discussed with the BBC at the World Economic Forum how technology could ease NHS pressures. Leif Johannson spoke about how more spending on areas such as AI and screening could prevent people having to go to hospital and said:
If we can get into an investment mode in health for screening or prevention or early diagnostics on health and see that as an investment to reduce the cost of sickness then I think we have a much better model over time that would serve us well.
This idea that technology is the silver bullet for all the NHS’ woes isn’t a new one and goes back many years. During the last Labour government, then prime minister Tony Blair spearheaded a National Programme for IT, which saw billions wasted on a technology system for healthcare that ultimately delivered very little and failed to take into account the diverse needs of a very fragmented organization that has specific local needs.
Healthcare Secretary after Healthcare Secretary has spoken about delivering a ‘paperless NHS’ for the UK or about how ‘digitizing healthcare’ is the solution to a sustainable NHS.
In the middle of last year the British Government unveiled its plans for transforming health and social care with digital technology (once again), hoping to capitalize on the momentum seen during COVID-19 for the adoption of technology. The plans include ambitions to see:
90% of NHS trusts with electronic health records by December 2023, and 100% by March 2025
The NHS App becoming a front door for interacting with the NHS and receiving personalized services, with 75% of adults registered for the NHS App by March 2024 and benefitting from an array of new features
Developing a national digital workforce strategy to bridge the skills gap and ensure the NHS remains an attractive place to work
Growing the specialist data and tech workforce through graduates, apprentices and experienced hires, creating an additional 10,500 positions
These are good aims and the plans are promising, where the focus is increasingly on interoperability and use of data across the NHS to drive change. However, with a general election just around the corner, I wouldn’t be surprised if the topic of the NHS is reduced to a snappy campaign from the political parties where technology is the answer to everything, with a reluctance to engage in broader structural issues that include capacity, funding, training, immigration and cross-party cooperation.
With tensions running high across the political spectrum, NHS workers striking for fair working conditions and citizens facing increasingly complex medical choices (and not to mention longer waiting times for care) - the future of the NHS will become a topic of conversation for the UK.
The key aim of this piece is to highlight that there is no silver bullet to solving the problems facing this highly valued organization that has helped the lives of millions and millions of people - particularly if that answer is just ‘technology’. Healthcare is a people business and even if systems and tools can be used to remove a lot of the heavy lifting in certain areas, care still requires funding, people and a recognition that structural changes are needed.
One solution on its own isn’t enough, without understanding the broader set of problems at hand. Politicians love to talk about ‘hard, grown up conversations’, whilst simultaneously offering the simplest of solutions. If we want the NHS to thrive in the future, we must resist the temptation to accept those as the answer.