I did a bit of a double take this week when I read that the NHS is the world’s largest purchaser of fax machines. Not, as I wondered for a moment, fax machines sending complex scans to impatient, Hugh Laurie-like clinicians across the country but rather normal, old school fax machines to deal with a normal, old school paper-based records system.
It reminded me that earlier this year, the Office for Budgetary Responsibility (OBR) projected that the proportion of GDP required to go into the health budget would need to rise from 6.9% in 2020-21 to 12.6% by 2066-67. That’s a worrying amount of cash. More worryingly, that’s the level of funding required for existing services to remain static. If we want to access and explore the potential of new health technologies, the development of new drugs, or meet the needs of the rise in numbers of people managing long term conditions like diabetes or cancer, then that’s extra money needed on top of the percentage rises.
And our wants and needs are endless: We need better access to mental health services; scheduled surgeries need to go ahead as planned; we need reductions in the waiting times for GP appointments; more midwives; fewer nurses leaving the service early; a recruitment plan for key NHS staff post-Brexit; an end to postcode prescribing, particularly for next generation drugs; and a solution to social care that treats the recipient and their carer with equal respect.
This isn’t even close to an exhaustive list of pressures on the NHS. It barely scratches the surface, but it is an indication of the demands we are making in 2017 on a service designed around demographics from 1948. It’s funding and operational model is, in places, literally a lifetime away. All of a sudden, the fax machines start to make sense.
So as the politicians and pressure groups send their 69th birthday messages to the NHS this week, I am desperately trying to keep my patience with populist politics. ‘Save the NHS’ messages may be an easy way to win votes, but who exactly is suggesting getting rid of it? No one, as far as I can see, is advocating a US-style system. This is an often-quoted and entirely pointless comparison – almost every other country in the developed world offers 100% access to care regardless of ability to pay. More importantly, those other countries and their different systems are frequently returning better patient outcomes than the NHS, particularly in preventative strategies or in treating conditions such as cancer.
I have no desire to be prescriptive about any future models for the NHS. Some will find sense in social health insurance models, others might argue for increased taxation, but something has to change and everyone who cares for the NHS owes it the chance of a genuine, cross-party approach to discussions about its future. The difficulty with not taking this approach is that we will end up in exactly the same place that we currently find ourselves - locked in a loop of applying emergency patches to the worst affected areas, and with little real means of supporting an exhausted workforce constantly being asked to do more with less.
A cross-party approach requires real bravery from the political leaders of all parties, but it also requires a leap of faith from the electorate. We worry about having services taken away from us rather than see the potential that a change in design or funding might offer, and it is this fear that feeds the knee-jerk populism which defends the status quo at the expense of everyone.
We would all like to see improved access to health services. We would all like to see the NHS workforce better supported and better rewarded for the excellent work they do. We all know that change is difficult. Surely this should be enough to bring everyone to the table with an open mind.
So for a change, instead of using the birthday celebrations as an excuse for taking to Twitter and entrenching the politics of the NHS still further, let’s be brave enough to put everything on the table, talk together about constructive change and offer a great institution a little critical care.
Jo Nove is a Partner at Charlotte Street Partners. She heads up our healthcare practice and is widely regarded as one of the UK’s most experienced public affairs specialists. Her career began in 1997 when she served as a member of the Shadow Cabinet Advisory team in the Labour Party, during that historic election campaign. From there, Jo moved into the world of public affairs and communications consultancy and has advised a range of clients on public policy, communications and reputation management strategies.
Jo can be contacted at firstname.lastname@example.org