The creation of the National Health Service seven decades ago was indisputably 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. The Prime Minister Theresa May was absolutely right to commit last week to increased long-term funding.
The NHS’s biggest task this century must be to adapt to profound shifts in the patterns of ill-health. When founded in 1948, it was principally dealing with working-age populations requiring one-off treatments. Today, people are living ten years longer on average. There are half a million more people aged over 75 than there were in 2010 – and there will be two million more in ten years’ time. They are also spending more years in ill-health than ever before.
Between 2015 and 2035, the numbers 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 ten inpatient bed days.
Today, 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 problems in isolation.
As we each seek to prevent, cure and manage illness through the course of life, we need support from care professionals that act as one team and work for organisations that behave as one system. This has been made difficult to do by historic administrative and cultural fractures – between and within physical and mental health, hospitals and general practice, healthcare and social care.
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. On behalf of the NHS nationally, I want to say thank you to all of our staff who have worked tirelessly this winter and to acknowledge the pressures they face every day.
As we approach the 70th anniversary of the NHS, now is the time to fix the cracks rather than paper over them: and 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, a key milestone 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.
For example in the Frimley system, in Surrey, joined up care is well underway.
Single multi-disciplinary care teams – comprising GPs, nurses, mental health, social care, therapists – are being created that are helping people avoid crises and stem rising emergency hospital admissions for the first time in years. They ensure all care is delivered smoothly and people tell their story once. Where people do arrive at A&E, the doctors there get help to find solutions for complex situations 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.
In addition to being more joined up and less fragmented, the NHS of the future needs to be proactive rather than passive on prevention, and empowering rather than paternalistic on 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, West Yorkshire, mental health navigators now take referrals from housing associations so they can identify problems early, helping reduce ill-health and prevent homelessness. In Blackpool and Fylde Coast, schoolchildren are encouraged to take part in a daily ‘Run-a-Mile Challenge’, helping to reduce high levels of obesity which causes diabetes and other illnesses.
If you have a life-long 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 mobile phone apps to help them manage their own health.
In urban Tower Hamlets, care co-ordinators in GP surgeries help people keep well by referring them to 1500 local voluntary sector organisations offering gardening, befriending, cookery, healthy eating sessions and a range of sports.
Initiatives such as these are now breaking out across the country, led by doctors, nurses and other staff, backed by health and care organisations working collaboratively in partnerships. The innovations that will help 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.