Why the NHS needs fundamental change in its delivery

Feb 6, 2020
4 MIN. READ

Demands on the UK’s National Health Service (NHS) are outstripping resources, requiring coordinated and creative planning to find a solution.

The NHS is a hugely-popular national treasure. It was founded in 1948 based on three core principles: that healthcare should be available to everyone, free at the point of delivery, and based on clinical need—not on the ability to pay. But, growing demand is stretching the NHS to its limits—severely challenging the deep-rooted public faith in the institution's ability to deliver.

The long-term plan

At the beginning of 2019, NHS England drew up its long-term plan to adapt services over ten years’ time. Frontline staff, patient groups, and experts contributed, with the goal of improving patient care and health outcomes.

The results came in the form of an ambitious and practical strategy from NHS England. It aims high—with a promise to save up to half a million lives—targeting measurable improvements in health outcomes and inventive strategies for stretching resources.

Fundamental to the plan is a commitment to finding new ways to organize services. Leadership is looking to lay bare the areas for improvement and develop flexible and innovative ways to achieve more with less. The hope is that continuing advances in medicine and technology, together with pragmatic and creative approaches to problem-solving, can drive better outcomes and efficiencies in the future.

While change is necessary, it can also be perceived as a threat: no one wants a national treasure to become fractured and unrecognizable as it strains to adapt to new standards, structures, and targets. So, can the plan help NHS evolve alongside current and future needs while remaining true to its core values?

The challenges

The NHS has been facing unprecedented difficulties over the last ten years, with prior to 2019, flatlining funding (below the 4% real-terms growth per year needed) and demand outstripping resources.

There are significant workforce vacancies of more than 110,000 staff, the impact of austerity cuts, and increasing demands on services. All this comes at a time when patient needs are changing and will continue to do so in the future—particularly with an aging population, increasing rates of obesity and associated conditions, and those who have multiple health problems.

Attendances at Accident and Emergency (A&E) have risen by over 40% in just under 14 years. The beginning of 2018 saw particular challenges with bed occupancy increased by cases of norovirus and the worst flu season since the winter of 2010 to 2011. The higher numbers of emergency acute admissions are putting unsustainable pressure on NHS resources.

How is the ten-year plan measuring up?

The NHS has opened itself up to scrutiny and allowed light to shine on some of its more intractable problems—nothing is off-limits.

The plan deserves credit for a refreshing openness to fundamental change, where there’s permission to recognize and address problems. It has created a healthy atmosphere for good ideas and proven best practices that can deliver transformation. At this stage, the plan remains true to core NHS values—but needs to address the areas that just aren’t functioning well (or at all) anymore.

An important goal of the long-term plan is to keep people out of hospitals so only those who truly need inpatient care end up in a hospital bed.

Future policy and planning have to hold fast to this vision and make fundamental changes in the current system. Funding, resources, and procedures must be structured to accept patients into a hospital only when services in the community have been considered and rejected as inappropriate. A hospital bed should be a ‘last resort’ in a funnel approach, where all earlier options have been ruled out.

A focus on preventative care is another pragmatic and sensible solution. Preventative care allows the NHS to spend less money by intervening early on. At a later stage, symptoms might become much worse, treatment more complex, and the expense much greater.

One year since publication, the ten-year NHS plan is evolving in a positive direction, and the goal of reducing A&E hospital admissions remains top of mind.

"By increasing emphasis on preventative care, primary care, and social care, officials hope to mitigate the pressure on inpatient services. If they succeed, there is hope for continuous, high-quality care through the NHS for many years to come."

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By Simon Jupp
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