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At 70 years old, I hope to feel much the same as I do now – but maybe with a few more wrinkles, certainly less hair, the scars of some of the things I’ve lived through and, hopefully, the resilience to cope with the inevitable aches and pains that come with ageing.
Who knows how that will work out!
And when I look at the NHS at 70 I think I see some of those same signs. The ambition is still the same: to be there so that “everyone – rich or poor, man, woman, or child – can use it or any part of it”. But there are definitely a few more wrinkles and maybe a few scars.
The opportunity of a birthday gives us pause for thought about how we face the decades ahead with the benefit of experience and the energy to face different challenges.
Experience has taught us many things. In 1948 when the NHS was born the average life expectancy for a man of my age was 65, with half of all men dying before they reached that age. Now life expectancy is 79.2 years, thanks to advances in medicine, the brilliant care and support provided by NHS staff every day, and public health advancements such as the smoking ban in public places and the legal requirement to wear seatbelts in cars.
But despite living longer, we are not necessarily living healthier, or happier, lives. Perhaps the most significant shift over the past 70 years has been the increase in long term conditions (LTCs): seven in every 10 hospital beds are occupied by someone with a LTC, and £7 in every £10 is spent on supporting LTCs.
By 2035 two-thirds of adults are expected to be living with multiple health conditions and 17% will have four or more conditions. One million people over the age of 65 report being lonely. Such loneliness and social isolation, which affects people of all ages, leads to poorer health, higher use of medication, increased falls, and increased use of GP services.
Life is not great at 70 – or any age – if you cannot live life the way you want, and experience has taught us that there is not a pill for every ill.
Now the time has come to reframe the conversation and to move beyond the purely clinical: to support people to live their lives in a way that matches what matters to them.
Over the last few years evidence has been mounting that for many people, community-based support focused on meeting psychosocial needs can make a huge difference to their wellbeing, and to the way in which NHS resources are used.
We know that by supporting people to develop the knowledge, skills and confidence to manage their own health and wellbeing, they will experience better quality of life and, not only that, but they will also need fewer interventions by formal services.
A recent study by the Health Foundation found that patients who were most able to manage their health conditions – what was described as the most ‘activated’ – had 38% fewer emergency admissions than the patients who were least able to; had 32% fewer attendances at A&E; were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere; and, had 18% fewer general practice appointments.
When we look at the resources available to the NHS, perhaps we sometimes miss one of the greatest resources we have – the very people using the service.
A recent review by the University of Westminster looked at the impact of social prescribing on healthcare demand. This showed average reductions following referrals to social prescribing schemes of 28% in GP services, 24% in attendance at A&E and statistically significant drops in referrals to hospital.
And an analysis of spending by people who were eligible for conventional NHS Continuing Healthcare (CHC) who took up a personal health budget (PHB) showed an average saving of 17% on the direct costs of home care.
The evidence is mounting, and we have used it to develop our comprehensive model of personalised care. Care that recognises we need to start with what matters to people, ‘from the cradle to the grave’. And that needs to be true whether they are trying to maintain good health, whether they are managing long term conditions or if they are living with complex chronic conditions.
The personalised care model meets people at their point of need: social prescribing, personal health budgets, shared decision making, personalised care and support planning, patient activation, and Choice all make up the model.
Taken together systematically and at scale, we can ensure that our population and our NHS are fit to face the future decades.
- Consultation on the NHS Long Term Plan runs until 30 September 2018.