This article is part of a series celebrating the NHS’s 70th Anniversary, sponsored by Philips. Find out more about Philips’ solutions here.
It is a mark of how far medicine has come that Sylvia Diggory, the 13-year-old patient visited by Nye Bevan on the first day of the NHS on 5 July 1948, may not have needed a health service bed at all had she fallen ill today. Diggory had been in hospital for several weeks before Bevan’s visit and would remain there a few weeks more before happily making a full recovery. Yet nowadays, according to Great Ormond Street Hospital, most cases do not require a hospital admission. They can be treated through observation.
The NHS bears little relation to the one which existed in 1948 — other than the cherished principle of treatment for everyone, regardless of means, which remains. There are whole areas of treatment, routine today, which did not exist in 1948. Hip replacements, for example, did not arrive until the 1960s; organ transplants until the 1970s. On the other hand, there are treatments which were routine then, such as removing tonsils from children suffering from sore throats, which are now being curtailed as their medical worth becomes questioned. Varicose vein operations, we learned last week, are also to be dropped in all but a few cases.
Technology, such as keyhole surgery, is vastly improving patient experience, while reducing hospital stays and the length of time it takes to recuperate. Yet at the same time medical advances are forever putting upwards pressure on the NHS budget. That is the underlying reason why its budget has swelled from £11.4 billion (in today’s money) in 1948/49 to £144 billion today.
Last month, the government announced an extra £20.5 billion a year will be pumped into the NHS by 2023 — a real-terms rise of 3.4 per cent a year. That is higher than the real-terms rise of around 1 per cent a year with which the health service has made do since the public debt crisis of a decade ago. Yet it is still below the 3.7 per cent a year rise which the NHS has averaged since 1948. During the early years of this century, as Tony Blair promised to increase per capita NHS spending to the EU average, the NHS budget was rising by nearly 8 per cent a year. In 2000, when Blair made his promise, the UK was spending 6.3 per cent of GDP on healthcare, while the EU average was 8.5 per cent. By 2009, the Labour government had slightly exceeded its target, and healthcare spending was 8.8 per cent. However, by that time, the EU average had moved on to 10.1 per cent. If Theresa May was to repeat Blair’s promise to raise health spending to the EU average, according to the health think tank the King’s Fund, it would require an extra £43 billion of spending per year by 2020/21 — more than twice what the government proposes.
Could we, and should we, get there? Setting a target purely in terms of spending money gives the NHS a perverse disincentive to make efficiencies which could reduce bills. As Blair found when he set his targets for the NHS, you can reach them only to find they have been achieved through less-than-sensible means. A Blair target to reduce waiting times in A&E, for example, resulted in hospitals spending large sums hiring temporary nursing staff just for the days when they knew waiting times would be measured.
Yet healthcare outcomes need to be improved. An international comparison by the US think tank the Commonwealth Fund, gives the NHS top marks on efficiency and access, yet when it comes to measures such as cancer survival rates it slips to second-to-bottom place. In a report to mark the NHS’s 70th birthday, the Wellcome Trust, too, comes to the conclusion that ‘the UK appears to perform less well than similar countries on the overall rate at which people die when successful medical care could have saved their lives’.
In return for the extra money it says it will grant the NHS, the government has set an efficiency plan which, for example, demands hospitals free up 2,000-3,000 beds through moving long-term patients more quickly into social care. Hospitals have also been told to reduce what they spend on agency staff and to save money on procurement of equipment and drugs by pooling their buying operations.
The government’s plan for the NHS puts a lot of stock in technology. It now has a director of innovation and various initiatives to help bring forward ideas. One fast-developing area is that of personalised medicine, where patients are given more responsibility to monitor their conditions at home rather than have to keep travelling to surgeries. Whether the NHS can cut its number of beds further, though, is something which some people have questioned — the number has already fallen by more than half since the 1980s as less intrusive surgical techniques and better post-operative care has allowed patients to be discharged much sooner.
There will always be pressure for more money, always people claiming the NHS is in crisis. As for nurse shortages, they have been a factor in the NHS since its birth: six months after its foundation, there was a reported shortage of 48,000 — twice that claimed by the Royal College of Nursing now.
Yet even while we worry about the NHS, treatments will continue to advance. Treatments which do not exist now will become routine. We will live longer lives and enjoy better health. That has been the story of the past 70 years — and will surely be the story of the next 70 years too.
The NHS at 70
|Population 43 million||Population 66.6 million|
1 person = 1 million people
|Over 65s||Over 65s|
|Life expectancy||Life expectancy|
|Average BMI||Average BMI|
|NHS budget||NHS budget|
(in today’s money)
|Roughly £144 billion
(Source: Ipsos MORI)
|When the NHS was established
in 1948 there were
staff across the UK. Now there are
in England alone.
(Source: Health Education England)
of these are doctors, but the majority —
— are nurses
(Source: NHS digital)
of surgeons in England trained in other EU countries
(Royal College of Surgeons)
of NHS midwives in London are from elsewhere in the EU
(Royal College of Midwives)
|An estimated €300m of EU health research funds were received by UK organisations for health research between January 2014 and 2016
(UK Research Office)