Stephen Powis:
As the NHS approaches its 70th birthday, cracks must be fixed rather than simply papered over
The creation of the NHS 70 years ago was one of the greatest social advances of the last century. For the first time in our history, it replaced public fears about the affordability of healthcare with a service based on equity. Theresa May, the Prime Minister, was right to commit to increased long-term funding.
The NHS’S biggest task this century must be to adapt to profound shifts in patterns of ill health. When founded in 1948, it was principally dealing with working-age populations requiring one-off treatments. Today, people are living 10 years longer on average. There are half a million more people aged over 75 than in 2010 – and there will be two million more in 10 years’ time. They are also spending more years in ill health. Between 2015 and 2035, the number of older people with four or more diseases will double and a third of these will have mental ill health.
Incurable long-term conditions now account for half of all GP appointments, almost two thirds of outpatient appointments, and seven out of 10 inpatient bed days. Tackling multiple and long-term conditions is overwhelmingly the main business of the NHS, not the exception.
In response, we need a system that supports an individual’s complete needs, rather than treating each body part, illness, or care problem in isolation. As we each seek to prevent, cure and manage illness, we need support from professionals who act as one team and work for organisations that behave as one system.
This has been made difficult by historic administrative and cultural fractures. Opportunities to limit ill health are missed, patients get pushed from pillar to post, staff are frustrated when trying to “do the right thing”, hospitals pick up the pieces – and pressures build. Those pressures, which loomed particularly large this winter, are symptomatic not only of constrained funding but also of a system designed for a different era.
As the NHS’S 70th anniversary approaches, it is time to fix the cracks rather than paper over them. The good news is that it is starting to happen.
Over the next few weeks, the first parts of the country formally begin to work as integrated care systems, as England makes the biggest national move to integrate care of any major Western country. They are comprised of all local health and care organisations – including local government with social care – working in partnership and pooling resources, and their task is to show how to build the care systems that can better serve the needs of the public.
In the Frimley system, in Surrey, joined-up care is well under way. Single multi-disciplinary care teams – GPS, nurses, mental health, social care, therapists – are being created to help people avoid crises and stem rising emergency hospital admissions for the first time in years. They ensure that all care is delivered smoothly and that people tell their story once.
Where people do arrive at A&E, doctors there get help to find solutions that prevent unnecessary hospital stays. If admitted, care teams work proactively to help people get home and avoid them getting trapped: a person over 80 who spends 10 days in hospital loses 10 per cent of muscle mass, equivalent to 10 years of ageing. Not only is this better for patients, but hospital staff have said they have “more time to care” and their jobs feel less stressful and more rewarding.
The NHS of the future also needs to be proactive on prevention, and empowering rather than paternalistic in helping people look after themselves. For example, by joining forces with local government to keep houses warm, safe and dry, the NHS can reduce lung and heart disease, saving £70 for every £1 spent.
In Wakefield, mental health navigators now take referrals from housing associations so they can identify problems early, helping to reduce ill health and prevent homelessness. If you have a lifelong condition you are an expert needing support, not a passive recipient of care. In Dorset 1,000 patients with diabetes, lung disease and heart disease have had free phone apps to help them manage their own health.
Initiatives such as these are breaking out across the country. The innovations that will help to tackle the issues facing the health and care system will be found on the front line. We need to nurture them, bottle the best ones, and spread them to create the NHS of the future.
Professor Stephen Powis is NHS England National Medical Director