Our 'culture of short-termism' risks condemning our NHS to a dismal future
5 min read
Lord Patel argues that there is a 'culture of short-termism' in the NHS which prevents it from looking beyond the current crisis.
Barely a day goes by without a news story emerging about one crisis or another in the NHS and adult social care. But if all our attention is spent firefighting one short term crisis after another, we run the very serious risk of sentencing the country’s most beloved institution to a dismal future which is immeasurably worse than its current state.
Since the summer of 2016 I have had the honour of chairing a Select Committee in the House of Lords which was established with the explicit aim of examining the long-term sustainability of the NHS. The Committee comprised a wide range of experts, including of surgeons, doctors, former health ministers and others who still play an active role in the NHS in England and in local government. We heard from over 100 oral witnesses and received 180 written submissions, which amounted to half a million words of written evidence.
Our conclusion could not be clearer. Is the NHS and adult social care system sustainable? Is it sustainable as it is today? No, it is not.
We concluded that a tax-funded, free-at-the-point-of-use NHS should remain in place as the most appropriate funding model both now and in the future. However, if this is to be maintained, some things need to change.
We found that a culture over short-termism prevails in the NHS and adult social care system, with the Department of Health either unwilling or unable to look beyond the current crisis. To tackle this, we need political consensus on the way forward, which the Government should seek to initiate.
Building on this consensus, we believe an independent body, charged with making evidence-based projections on the health and care needs for the next 15-20 years should be established. The Office of Health and Care Sustainability would monitor the impact of changing demographic needs, the workforce and skills mix needs in the NHS and the stability of health and social care funding relative to demand, providing much-needed forward thinking to help stabilise and protect both health and care services for the future.
Funding was inevitably central to our inquiry but simply asking for more money is not the solution. Funding for health will need to increase; the reduction in health spending as a share of GDP over the last decade cannot continue, but we believe this should be in an affordable way. We ask that in the future health funding will need to increase at least in line with growth in GDP.
We also found that, in the past, funding has been too volatile and poorly co-ordinated between health and social care. This has resulted in poor value for money and resources being allocated in ways which don’t meet patient needs. So beyond 2020, a key principle of the long-term settlement for social care should be that funding increases reflect changing need and are, as a minimum, aligned with the rate of increase for NHS funding.
The extra money for social care in the budget was welcome but it will need more before 2020 to firmly close the funding gap, and make up for many years of underfunding and the rapid rise in pressures on the system. To allow better co-ordinated between funding for health and social care we think that the budgetary responsibility for adult social care at a national level should be transferred to the Department of Health which should be renamed the ‘Department of Health and Care.’
As many of the Committee members who have worked in the NHS will understand, the workforce is the lifeblood of the NHS. But it is being undermined by a lack of a comprehensive long-term strategy to secure the appropriately skilled, well-trained workforce that the health and care systems will need in the future. Only a substantially strengthened and transformed Health Education England can do this. Furthermore, we need to understand the low levels of morale and poor records on retention within the workforce. This means assessing the impact of over-burdensome regulation, unnecessary bureaucracy and a prolonged period of pay restraint.
Finally, we found widespread agreement on the vision for the future service vision—integrated health and care services delivering more care in primary and community settings—but the system is not there yet. The needs of patients have changed so the system needs to change with them. We know service transformation is happening, but we urge further action reconsider the model of primary care, reshape secondary care and ensure that specialised services can be consolidated further. A renewed drive to realise integrated health and social care is also badly needed.
The NHS has been serving the nation well for almost 70 years and we know it can continue to do so well into the future. We hope our report will provide a starting point for others who continue to work to secure the long-term sustainability of both the NHS and adult social care.
Lord Patel is a cross bench peer in the House of Lords and is Chair of the Select Committee on the Long-term sustainability of the NHS
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