Reflecting on 75 years of challenges at the NHS

Improved life expectancy, and a changing demographic

When the NHS was formed 75 years ago, life expectancy was shorter, in 1959 the average life expectancy was 69.69. The nation’s health was very different back then, and it’s a testament to how far healthcare has come during that time that now, in the UK, average life expectancy has increased to 81.77. This is truly worth celebrating, but with it comes the complexity and extra demands of an aging population, which was not there in the early decades of the health service.

The size of the population and its demographic make-up was probably the largest original challenge and is a continued challenge for the NHS.

Workforce

Workforce challenges are not new. In the early days of the NHS, having been converted from a wartime health service, certain levels of skill and care were there already so it had a good starting foundation. However, even then there were nurse shortages.

Over the years we have moved from a generalist workforce, optimised by the family GP, to the ultra-specialist professionals that we now need to have. The volume of activity that nurses and doctors now need to do has increased, as has the range of specialist activities that nurses are now trained for. Recruiting staff with the right expertise and specialisms is tough.

The NHS has tried various different ways of addressing the problem. It has provided significant training, and invested in attracting talent from other parts of the world. However, there is a global shortage of clinical workforce as highlighted in recent media reports.

The NHS has recognised that we have to change the way in which we look at the workforce challenge, and the NHS workforce plan will be critical to define and deliver change.

One way to address staffing is to alter the skills mix within the workforce, for example training nurses to add more clinical skills to their portfolios and other healthcare professionals to broaden their remit.

Another huge potential enabler which may help address the NHS’s workforce challenges is digital interfaces for patients. Using technology to make it easier to access and deliver care is a huge opportunity which we are certain to see being progressed in the near future.

The next few years are likely to see significant change as the NHS works hard to ensure it has the people and process in place which are needed to deliver the wide range of services it offers amid growing demand.

Rise in preventative initiatives

In Europe, there is a recognition that throwing more and more money at bigger and better hospitals may not be the way to improve the general health of the population. In the UK, the NHS now consumes a very significant part of the national gross domestic product. We are spending more money although if you look at international comparisons, not any more than the universal healthcare models of our peers.

This is why you have got everything from social prescribing – go out and have a walk, join the gym, provide a bike – to population health measures like diet control. The idea is to get things like heart disease and blood pressure under control at a population health level, and avoid hospital admissions. Using population health interventions, which are not just medical but social and environmental, is becoming increasingly important to try and prevent people getting ill in the first place.

However, there will always a need to provide healthcare, and the scale and associated cost of this is connected the to the size, age and complexity of the health conditions of the population. We are making great progress in medicine, and social prescribing and population health measures will play a part in helping keep our population healthy. As medicine advances however, we can expect to see additional budgetary requirements as the cost of medicines and other treatments continues to grow.

Advances in integrating care

Integrated care is a tremendous idea but it is still in the implementation phase rather than going full steam ahead.

There is a policy and care dilemma emerging between a very heavily medicalised US-type model – that has been the model for most of Europe – and more ‘in-the-community/out of hospitals’ models, where the improvement of the general health of the population is the priority.

An example of this model is seen in Japan. They do have big hospitals but also smaller community ones and get people back out of hospitals and into the community. We will need to look at how integrated care can help address the budgetary and structural questions about where we most need to invest, to help us adjust and adapt the NHS for the future.

Conclusion

Bruce concluded by stating it has been an honour and a pleasure to work within healthcare and witness the transformation that has taken place through the decades.

There will always be challenges but the strides made to date point to an exciting future. Blake Morgan are leaders in innovation and have collaborated on life-changing projects. We do not know what the future holds but given the pace of developments in medicine, it will be enthralling to see how the healthcare sector adapts and grows.