The NHS is 70 years old, but hard choices must be made about the next 70 years ... and they’re decisions we all need to take
The future of health and social care is not just the job of politicians and civil servants — everyone has a personal responsibility, writes
The 70th birthday of the NHS is fast approaching. The actual date is July 5, but events marking the big date have started. There’s plenty going on in Northern Ireland — our localised version of the health service is 70, too.
It’s a time to celebrate the amazing things the service and its staff keep achieving, despite all the problems and challenges. The birthday is also an ideal point to think about the future and how we can build stable foundations for health and social care services for the years ahead.
That means some serious debates and vital policy decisions. The future of health and social care is not just the responsibility of politicians or civil servants. It belongs to all of us and all of us have a part to play in shaping its development.
The big debates are simply too important to watch from the sidelines or leave to someone else.
Look, for example, at the long-term funding issue. It’s widely agreed that the costs of providing health and social care are going to climb in the decades ahead as more and more people live longer. If we want a world-class service to be maintained as demand for care steadily rises, there will inevitably be decisions to be made on taxation and funding levels.
It’s obviously not for me, as a civil servant, to state my opinions on tax, or public spending, rates. But I can say it’s an issue we will all need to think and talk about.
Social care is an important part of this. It’s made more complicated by the fact that, unlike healthcare, it’s not free to everyone at the point of use.
Care home places come with charges. Across the water — but not here — there are also charges for domiciliary support (care provided in your own home).
I can declare a personal interest here. I’m just about to turn 53. By the time I’m most likely to need social care support, it’s expected that there will be significantly more older people around in the same situation.
But don’t take my word for this. Look at the population projections in the bulletin on demographics published in April by the Northern Ireland Statistics and Research Agency.
Over the decade up to 2026, the population aged 65 and over in Northern Ireland is projected to increase by 25%. In the same period, the population aged 85 and over in Northern Ireland is projected to increase by 31.4%.
And, by 2041, it’s expected that one in four of the population here will be in the 65 and older category.
Yes, you read that correctly. One in four. Including me — hopefully.
What will social care look like by then? And who will foot the bulk of the bill for it? Will that be my children and their generation through their taxes? Will those of us who can afford it be required to personally contribute more?
Questions like that are all part of a vital debate. Here’s another one. What matters most to you when it comes to your hospital treatment? Location? Quality? Waiting times for treatment? It’s all a question of balance.
Clearly, it’s not feasible to have a functioning hospital emergency department at the end of every street. And, obviously, just one for the whole of Northern Ireland is not sensible, however high-tech and well-staffed it might be. So, we end up somewhere in the middle of those two extremes.
There are similar choices to be made with other hospital services. For instance, the longterm plan for tackling waiting lists includes developing elective care centres — stand-alone day surgery and assessment centres. That’s an important part of the transformation agenda for our health and social care system.
How far would you be prepared to travel for an operation, or a medical test, if you knew it would be carried out promptly and expertly, it wouldn’t be cancelled at short notice and you wouldn’t be stuck longterm on a waiting list? Again, that’s a policy debate we all have a big stake in.
Then there’s the tough topic of healthy living and how we all play a vital part in shaping our own health. The phrase ‘lifestyle choices’ can very easily sound patronising. Healthy living can be about lots of things, including public information, open spaces, education, the environment, employment, poverty, housing and the pace of modern life.
The last thing I’m going to do is preach at anyone. So, I’ll stick to myself. I’m at an age now where I need to give more thought to healthy living. Challenging myself to do more exercise, control my intake of chocolate, cheese, lamb madras and a long list of other food favourites that sadly aren’t recommended by any doctors. I also need to listen to my GP’s advice on blood pressure and cholesterol.
And here’s the thing. If I ignore the advice, do I not have to reduce my expectations of what the health service can do for me in the years ahead? Is it not a bit like having a personal contract with the NHS, doing my bit?
Of course, there’s a lot more to all this than just individual choices. But personal responsibility does come into it.
We can’t sit this one out.
❝ By 2041, it’s expected that one in four of the population here will be in the 65 and older category
❝ There’s also the tough topic of healthy living and how we all play a vital part in shaping our own health