The National Health Care Service: An illustration of Myopia
As healthcare needs are becoming ever more complex, the NHS, or National Health Service, is thus far proving to be ever less adaptable in addressing them. The NHS refers to the public health services of England, Scotland, and Wales that were established at the end of the Second World War with the mission of providing comprehensive and free health services to Britons. Today, the NHS is swept up in the wind of change that seems to be emblematic of the UK overall, as a) healthcare does not constitute a pressing concern for the public, who rank Brexit as their primary concern, followed by immigration, with the NHS a distant third and b) the Conservative Party, under Theresa May, is viewed as more capable in affronting the NHS challenge, which signals a shift from the trust that the public traditionally showed to the Labour Party, now led by the thus far uninspiring Jeremy Corbyn, in dealing with healthcare.
The status quo of healthcare in Britain is distinguished by two constituent components, the inevitable interaction of which has resulted in the rather lackluster- to be put mildly- performance by the NHS: a rising demand for healthcare services by the UK populace coupled with a severe workforce shortage, in both personnel and resources. The epitome of that ailing condition of British healthcare was recorded in January, where at least 23 of the UK’s 153 hospital trusts declared “black alert”- the gravest level of warning indicating sheer inability to provide “comprehensive care” to patients. Rather than being a problem of quality of service provided, the NHS is plagued by a) inherent structural weaknesses dating back to its establishment in 1948, and in spite of the changes enacted in the past 70 years, but predominantly by b) government under-resourcing. Primary responsibility thereby lies with the government and is manifested by both poor strategic decisions and budget cuts.
The NHS’ poor strategic handling is exacerbated by three distinct challenges that are facing the UK: a population that is at once, growing and aging, healthcare needs that are ever evolving (as evidenced by the cases of obesity, diabetes, or antibiotic resistance), and technological progress in medicine which is costing the NHS an additional 10 billion pounds per year. As the number of the elderly increases, from a staggering 11% (aged 65 and older) in 1951, to 16.5% in 2011 (ONHS) so does the number of people seeking healthcare services due to age-related illnesses rendered more complex by the broad scope of medical conditions by which they are affected. At the same time, the number of Britons accessing state care outside hospitals is falling from 1.79 million in 2008-9, to 1.24 million in 2013-4 (estimated by responses to the Association of Directors of Adult Social Services budget survey), thereby generating added strain on the A&E (the emergency department or casualty), which is struggling to absorb the additional incoming patients.
Even those fortunate enough to be processed by the A&E are often obliged to wait for lengthy periods of time; the number of patients left on trolleys for between 4-12 hours, for instance, has increased from 11,329 patients in December 2010 to 38, 848 in December 2014 (NHS England). That same struggle is equally reflected in the A&E’s difficulty to recruit and retain workforce personnel. What thereby resides at the core of the problem is the massive increase in GP (general practice) demand that goes unnoticed or unaddressed by British healthcare policymakers and ends up overwhelming interrelated sectors, most notably the A&E. Expressed differently, British healthcare is afflicted by the lack of a long term, sustainable investment in general practice. Faced with 1.3 million GP consultations per day and with an additional 120,000 daily patients, relative to the number of patients treated five years ago, general practitioners (GPs) have bafflingly witnessed NHS policymakers not only withholding an increase but, on the contrary, decreasing general practice investment to an unprecedented degree of just over 8% of the healthcare budget. To cite a more specific example, the UK government reserved 700 million pounds to aid the NHS confront the winter pressures in 2015, but only 25 million of that was invested into GP, even though general practitioners constitute 90% of all NHS patient contacts.
The lack of investment constitutes but one of the strategically unwise decisions of the government. A cut in personnel from 12,000 nurses in 2003 to 5,500 in 2015 has aggrandized the pressure on A&E by inhibiting nurses from attending to individuals in their homes and thus preventing them from going to hospitals, unless urgently required. Elsewhere, the dismantling of NHS Direct and its replacement with NHS 111 was another colossal mistake that saw a reliable NHS service broken up and privatized, leading to the displacement of some 700 nurses and to the emergence of a localized service that lacks clinical expertise and is re-directing individuals to the A&E, increased its already elevated demand. The situation is so tenuous that a mere flu outbreak or a spell of cold weather could lead to a near-collapse of the British healthcare system.
The solution resides in investment; but simply pumping money into the healthcare system won’t work. The only way for investment to keep up with demand is for money to be allocated across all areas of the NHS so that one domain does not suffer the consequences of under-resourcing or lack of resourcing in another (e.g. as is the case, at present, with the A&E due to a lack of sufficient investment in GPs). It is what Phillip Hammond, the Chancellor of the Exchequer, in spite of his opposition to the expansion of healthcare funding- a stance that this article cautions against, rightly called “spreading best practice.” This means that in parallel to the focus on hospitals, more attention (and money) should be paid to community nurses and social care, greater access should be afforded to GP with primary care facilities becoming collocated with A&E services, and emergency care should function as a single unified system, not as a fragmented amalgamation of the NHS 111, pharmacists and the ambulance service. As the problem of closing local services due to centralization initiatives becomes more pronounced, the government should encourage devolution but should proceed with caution since at a period of austerity (and with the finalization of the terms of the Brexit deal ominously looming over) it risks further convoluting an already complicated system. If policymakers want to ensure that the NHS delivers on its promise to change, their best bet lies in crafting a synergetic local-national partnership.