So ingrained is the NHS as part of British life that it’s hard to imagine it disappearing. But it can’t go on as it is: its budget is being squeezed while its costs are rising and people are demanding more from it than ever. We want ongoing treatment for chronic conditions; exemplary care for our growing elderly population; the latest drugs; the highest standards of care across the country; and the NHS's founding principles – the provision of universal care free at the point of use – to be adhered to.
Earlier this year The Spectator held its first health lunch with a round-table discussion to coincide with preparations for the first issue of Spectator Health, a new quarterly magazine focusing on health and wellbeing. The theme for the discussion was ‘Healthy optimism – delivering a world leading health service’, and the guests were the people who are shaping the future of healthcare in Britain – with representatives of clinical staff, patients’ groups, the drug companies creating the medicines of the future, and all parts of the NHS – providers and watchdogs. They were in conversation with The Spectator’s editor, Fraser Nelson, its political editor, James Forsyth, and the chairman of Press Holdings Media Group, Andrew Neil.
Jeremy Hunt, the secretary of state for health, opened the discussion with an impassioned speech about how highly the NHS is regarded. On whether or not the NHS is sustainable in the long-term, he said:
“‘I think absolutely it is, and I’m aware that that’s a view that won’t be shared by everyone around this table. But I think in terms of the things that it remains, it’s the single reason why more people are proud to be British than any other … and what it is that they like about the NHS are the values that it represents and more than anything else the principle that no matter who you are, young or old, rich or poor, city or country, you can expect good care and treatment from the NHS, and I absolutely believe that we will have an NHS that delivers that for many generations to come and I would challenge anyone who disagreed with that because I think we can deliver that’.
Although Hunt said that some people might not think the NHS is sustainable, that view was not given voice. But around the table it was accepted that the NHS, despite near-constant reorganisation, needs to see changes not to its management, but more transformational change to care provision.
The secretary of state set out several areas in which he thinks the NHS needs to reform - and to succeed - in order to be sustainable: it needs to ensure the highest standards of care; to revolutionise its out-of-hospital care, moving from prevention to cure; to look after people with long-term conditions as well as it looks after patients in hospital; and to develop a stronger culture of innovation and change, and adopt new technologies more readily.
Were the NHS a private company, Pfizer's UK's managing director Jonathan Emms observed, it wouldn't primarily think about how it was organised – it would think about patients first.
Putting patients first – and treating ‘the whole person’ – were constant themes of the discussion. It was taken as a given that the NHS needs to keep people well without simply treating them when they are ill.
Michael O'Higgins, the chair of the NHS Confederation, agreed. He said ‘we're stuck with the care delivery model from the middle of the 20th century but we have a population which is now very different’. He advocated treating the NHS's ‘top two per cent of customers’ – those who it sees most frequently – better,
The NHS is not an integrated system. Chris Hopson, the chief executive of the network that represents NHS Foundation Trusts, talked about how 'fragmented' the system is, with many different bodies responsible for commissioning services and trusts trying to patch together different services (social care, acute care, mental and community health, to name but a few) to provide healthcare to the community – and said that the call for further integration of Britain's system of healthcare provision is ‘pretty much unanswerable’.
The call for integration is also coming from the opposition. Labour's shadow minister for public health, Luciana Berger, looked to the potential for integration of care to save money by removing duplication of services, and said it could enable patients to better manage their own care as they would have a smaller number of points of contact with the health system.
Andrew Neil asked about 'big data'. Will the NHS be able to use the vast quantities of data it collects constructively? Perhaps it already is. Much of the evidence for the link between smoking and lung cancer came from hospital data collected in the UK. But there's more that data can do, and as a single healthcare provider collecting so much information, the NHS is uniquely well-placed to capitalise on it. Using electronic GP records as well as hospital records could help to establish links between lifestyles and diseases and drive better outcomes for patients.
If people think the NHS hasn’t moved on, they forget where it was 30 years ago. Cancer Research UK recently showed that today, half of those diagnosed with cancer in the UK can expect to live for at least ten years. In the 1970s, half survived for less than a year after their diagnosis and only a quarter survived for ten years. There are more treatments for mental health problems, and better treatments mean that people spend less time in hospital.
And when it comes to innovation, some of the NHS's weaknesses turn into strengths. Some of the biggest gains in healthcare come from standardisation and treating patients with the latest best practices. The NHS's all-encompassing coverage means that it should be possible to have a simple model to spread innovation and treat patients well: NICE to say what clinicians should do; NHS England to help them do it; and the Care Quality Commission to check that they have done it.
But the biggest innovation, the secretary of state said, 'would be to have a system in which the patient would be the strongest voice in decisions about their care'. And perhaps if patients feel in charge of their care the NHS can help them be healthier throughout their lives.
In attendance were:
Luciana Berger MP, Shadow Minister for Public Health
Stephen Dorrell MP, Chair of Health Select Committee
Jonathan Emms, Pfizer
James Forsyth, Political Editor, The Spectator
Chris Ham, King’s Fund
David Haslam, NICE
Chris Hopson, Foundation Trust Networks
Jeremy Hunt, Secretary of State for Health
Martin McShane, NHS England
David Montgomery, Pfizer
Andrew Neil, Chairman, The Spectator
Fraser Nelson, Editor, The Spectator
Michael O’Higgins, NHS Confederation
Max Pemberton, NHS Doctor & Editor of Spectator Health
Jeremy Taylor, National Voices
Spectator Health is a free supplement. The first issue was published with the May 29th 2014 issue of Spectator and is available on line at spectator.co.uk/health