How does the NHS adapt to its challenges?
THE play Nye is from the National Theatre is showing in cinemas throughout the region. Try and see it if you can.
Michael Sheen is brilliant as Nye Bevan. Bea Holland, who plays Jennie Lee and Tony Jayawardana who plays Winston Churchill are also very good.
The play shows Bevan’s struggles to become an MP and then to found the NHS, at the same time neglecting his father and wife, seen as flashbacks as he lies on his deathbed. The play ends with a paean to the success of the NHS and Bevan’s part in founding it.
Trouble is after more than 75 years, having improved the health of the nation, the NHS is in trouble. What can and should be done?
The basic problem is that the population is ageing, and older people need more healthcare, while at the same time the cost of equipment and drugs keeps going up. Health experts agree that the cost goes up about 2% a year.
The 1997 Labour government managed to keep up with this by putting up National Insurance,and waiting lists went down.
Since 2010 the Coalition and Conservative governments have not matched this increase resulting in the present squeeze on budgets, and many less well off people seeking private health care.
But leaving party politics aside, increasing the budget every year is unsustainable in the long run and ways have to be found to keep the budget under control and deliver excellent health care.
There are two obvious solutions. One is taking pressure off hospitals by improving care in the community, so that older frail people either do not have to go to hospital, or can be discharged more quickly once their treatment has been completed. Councils fund social care, and at the moment they have had their budgets cut and are finding it extremely difficult to fund it.
A government with guts would reform the rating system to give local authorities more resources. Reforming community charge would require considerable political courage, but that doesn’t mean it should not be done. The other, perhaps more obvious solution is to try and make people healthier.
A recent study by Exeter University concluded that physical activity in the outdoors saves treatment costs of more than £100 million, and reduces the incidence of heart and chronic lung disease, stroke, cancer and diabetes.
Many illnesses are also caused by the wrong food, smoking or excessive consumption of alcohol. Trying to change lifestyles could reduce the incidence of these. It is not a universal panacea.
Many illnesses are genetic and inherited, and many are due to poor conditions. We should remember too that it will be harder in a poor region like the North East where many children suffer the effects of poverty. During the period 2000-2010 spending on public health and preventative health measures was substantially increased. Smoking is a cause of cancer which can be controlled.
The Labour government pushed ahead with the banning of smoking in enclosed environments, despite considerable opposition, including from its own supporters. Now everyone accepts this as normal.
Smoking decreased considerably during that period and has continued to do so until recently.
Worryingly a recent study by the World Health Organisation has shown it is now on the rise again, particularly amongst young girls. Whether vaping is any better for you is a disputed point.
There are causes for hope. Rishi Sunak’s legacy measure to prevent young people starting smoking is a
The basic problem is that the population is ageing, and older people need more healthcare
welcome move, even if there are concerns about enforcing it.
The number of hours devoted to physical education in schools has fallen by 40,000 hours since 201112. Kier Stamer has committed to halting the decline in access to team sports and PE in schools. Providing facilities for exercise is also important.
Not just school playing fields but also some parks and other open spaces have been sold off for development as Councils are strapped for cash. Gateshead Council recently was forced to close two swimming baths. Access to healthy exercise is not easy for everyone.
But perhaps the biggest obstacle to promoting healthy lifestyles is a poor diet. Obesity is a big cause of ill health in later life, and Britain is one of the most obese nations in Europe. Poor diet is largely to blame. Dealing with this is difficult. Food distribution is in the hands of a few supermarket chains, and food production is in the hands of a few large companies. Reducing sugar content would be a major advance.
Nestle is one of the biggest producers of food containing excessive amounts of sugar, but at a recent shareholders’ meeting the company resisted an effort to reduce sugar content, saying they had to maintain commercial flexibility, and food was a personal choice.
If we are to get a grip on improving diet, then the big food companies have to be confronted. The industry can find sugar substitutes, just as the petrol companies eliminated lead in petrol.
The measures I suggest cannot be implemented overnight. They require courage, commitment and a willingness for the long haul.
When he was Secretary of State for Health Jeremy Hunt said he was so busy dealing with immediate crises that he could not think long term. But if we do want to keep an excellent health service and properly fund it then we have got to ensure the population lives more healthily.