Who is responsible for transforming the NHS?

The NHS will need innovation, transformation and the public to take more responsibility for their health if it is to survive the long-term pressures draining its will and resources

Celebration of a coronavirus all-clear will still be echoing around the nation as the NHS turns to face its next challenge.

Perfect storm after perfect storm is rolling over the horizon: a mountainous backlog in surgery and cancer treatments, an ageing population and an obesity epidemic, recognised as a contributory factor to the UK’s COVID death toll, seemingly tattooed onto the national identity.

How then to navigate yet more Treasury jeopardy? How to recalibrate the complex and arcane NHS structures populated by more than 1.1 million staff, 1,250 hospitals and 7,454 GP practices that deal with a million patients every 36 hours?

These questions are absorbing the energy and ingenuity of politicians, NHS executives, social care experts and the private healthcare sector.

The bright lights are technological advances, supercharged out of necessity through the pandemic, that are connecting patients to treatments through computers and smartphones. The digital revolution is also reshaping the potential for more care to switch from expensive clinic and hospital settings to the home.

Chris Hopson, chief executive of NHS Providers, the membership organisation for the NHS hospital, mental health, community and ambulance services, believes the nation is facing significant threats from an ageing population living longer with multiple co-morbidities and the resulting extra pressure on NHS finances, as well as acute staff shortages.

“Demand for NHS services is rising by around 4 per cent a year, but we’ve just been through a decade of the longest and deepest financial squeeze in NHS history, when funding went up by around 1.5 per cent annually,” he says.

“We will also have to live with COVID for some years to come, but the underlying, long-term challenge is that you might argue we have a ‘National Illness Service’ geared around treating people when we know we will have to get much better at looking after ourselves and support citizens to do that.”

Smartphones managing health

The Office for National Statistics forecasts that by 2030 one in five people in the UK will be aged 65 or over, while the number of people aged 85 and over will double from 1.6 million in 2016 to 3.2 million in 2041. Yet 84 per cent of the population has a smartphone and access to a blizzard of diagnostic, treatment advice and support apps.

“There’s a real opportunity here,” says Hopson. “The vast majority of the nation has smartphones that enable them to track their weight and get access to advice around fitness which gives us scope to, if we can configure our health services, use smartphones to help people manage their health.”

He believes a new class of healthcare professionals could also be developed to support and school the public towards healthier lifestyles and less reliance on care. But all new initiatives and structures are freighted with the burden of social deprivation, employment population densities, the environment and health inequalities.

“It is clear that to keep pace with care demands, the NHS is going to have to do things differently,” says Hopson. “The NHS will go as fast as it can. For example, it moved to online GP consultations during the pandemic at real speed, which gives confidence that it can change pace and direction.

“But we will have to think quite carefully how we go forward and how we deal with the things that anchor us to the current model, such as the way buildings are configured and jobs are structured.”

Health secretary Matt Hancock laid out a white paper of reforms in February designed to strip away bureaucracy, modernise systems and boost local integration of services so they can withstand long-term demands. 

Power of transformation

NHS Transformation Unit, which focuses on service redesign to aid recovery from the pandemic and improve care long-term, is devising fresh approaches to tackle issues such as surgery waiting lists and connecting the public more efficiently and rapidly to diagnosis, treatment and care.

It is making the best of NHS resources and sees gains in creating hubs for specialisms and the use of digital technologies to support care in virtual wards away from hospitals.

“There also needs to be a bigger agenda in terms of health prevention and how we do health management to reduce demand,” says Janet Budd, the unit’s chief executive. “There is a lot of collaboration through the NHS and an absolute will to recover and then build to cope with future demands.”

Andrew Corbett-Nolan, chief executive of the Good Governance Institute, a consultancy that advises NHS executives, health authorities and commercial clients, believes restructuring programmes need to have the mechanics to function in concert or reach the entire population.

“The trick to pull off will be to create a revolution where some parts remain exactly the same,” he says. “By that, I mean a commitment to the core principles of being free at the point of delivery. But there also needs to be a very grown-up conversation with the general public about playing their part, how they look after themselves, how they use health services and how they plan for old age. We also need more research to help understand what influences personal choices and behaviour; social research is as important as clinical research.”

Rearranging healthcare furniture in terms of responsibilities and demarcations seems a national pastime, but it can undervalue the importance of human behaviour.

“Disease prevention has always been the Cinderella of our healthcare system, attracting less than a tenth of the funding devoted to treatment,” says Dr Robert West, professor of health psychology at University College London’s Health Behaviour Research Centre. “Although it is understandable in that we can’t ignore it when people have heart attacks or develop cancer, yet we can all too easily ignore it when people are building up health problems in the future.

“It is also irrational because disease prevention more than pays for itself. It has the benefit of helping people live longer and healthier lives, and reducing demands on our treatment services.”

Public behavioural change

Changing behaviour takes time and is unlikely to succeed within the timeframe of the government while the food, alcohol and tobacco industries have a powerful lobbying force and deep pockets.

“In the UK, most people already have a high level of motivation to improve their health. What we need to do is to harness that motivation by enhancing their capability and opportunity,” says West. “This has the added benefit of feeding back into motivation; we are more likely to want to do things if we think we will succeed.”

Dealing with the pandemic is a Herculean task; coping with what comes next will need planning, collaboration, innovation and investment across health and social care. The Department of Health and Social Care points to a £52-billion investment in the NHS this year on top of a £9.4-billion capital programme to build and upgrade hospitals to frame the government’s commitment.

“I’m always very optimistic when it comes to the NHS because of its amazing staff, who are the rocket fuel of progress, the goodwill of the public, combined with advances in research, life science and biotechnology expertise in the UK,” NHS Providers’ Hopson concludes. “We have the capacity to change healthcare to take advantage of these trends.”