This year the NHS turns 70 years old. For seven decades it has been there for us at times of most basic human need, offering care and compassion. The NHS has been a vital friend to millions: it belongs to the people, and is cherished by the public. I want to see it not just survive but thrive: the NHS deserves a secure future that gives us confidence that it will celebrate its centenary in a little more than 30 years from now.
All political parties declare their affections for the NHS and promise to protect it. There is a strong cross-party consensus on retaining a health service that is based on need, not ability to pay. Yet there are enormous questions on how the NHS is funded and how the system functions. In the autumn budget 2017, Philip Hammond, the chancellor, rightly put more money into the NHS, but the service has still endured the most austere decade in its history while funding for social care has declined almost every year since the start of the decade. Simply demanding more for less or promising more money without a plan for better care isn’t good enough. The re-emergence of rationing of care, waiting times that are on the rise, and deteriorating financial performance means that change is becoming urgent as well as important.
How do we make sure every patient gets high-quality care when they need it? How can we sort out the chaos caused by the disruptive reforms of 2012? How will we keep up with advances in technology, therapies and treatments? How can we deliver parity of esteem for patients receiving support for mental health problems? How do we join up health and care around the patient? And, how will we fund the health and care system sustainably in the future? These are just some of the questions that must now be answered.
That’s why it is time to renew the vision for the 21st century NHS. We should be optimistic and ambitious about what a national service can achieve. There is no reason why the people of this country should expect anything but the best health service in the world. We have the depth of clinical talent to achieve it and an extraordinary repository of scientific expertise which should help us push the boundaries of what is technologically and scientifically possible. Our vision should be of an NHS that provides high quality care for all, for now and for future generations.
Moreover, the vision for the NHS must recognise that it is an asset for our economy as much as for our people. Yet for too long its potential has gone untapped – which has meant that patients have missed out on innovations in care and the economy has created less wealth for us all. The government has published a terrific report on industrial strategy for life sciences. But the grim reality is that the NHS is simply not in a fit state to implement its sensible recommendations. We have had too many false starts on life sciences; Brexit means we can no longer tolerate the obvious gap between intentions and actions.
Change for its own sake is merely upheaval, which is what it has felt like in the NHS in recent years. As well as a broken system, the 2012 Health and Social Care Act has a more pernicious legacy: a response to any proposals for change that resembles post-traumatic stress disorder. It’s little surprise then that reforms has been avoided rather than embraced. In private, there is widespread acknowledgement that the current system is dysfunctional and not fit to deliver either for patients or for the life-sciences industrial strategy. NHS staff
at the frontline know this, and know that there needs to be a serious plan for change.
The real reasons why change in the NHS is so necessary is poorly understood. The health service doesn’t need to change just because politicians say so; politically motivated change has poisoned the case for reform. The NHS needs to change because the nature of the disease burden has changed; because scientific breakthroughs have produced novel diagnostics, drugs and treatments; and because technology means we have the opportunity to work more effectively. In short, high-quality care is a constantly moving target: to stand still is to fall back. That’s why we need to revive reform.
The deadlock needs to be broken and a way through offered for patients, for NHS staff, for our economy. That’s why this year, I will be leading an independent review of the NHS with the independent Institute for Public Policy Research (IPPR). This will tackle the tough questions that politics is struggling to address. After all, I’m a doctor not a politician, and the NHS is a patient that’s in need of help.
This originally appeared in the Guardian Opinion section.
Professor the Lord Darzi of Denham is Paul Hamlyn Chair of Surgery at Imperial College London and a surgeon working in the NHS. He was Parliamentary Under-Secretary of State for Health from 2007 to 2009.
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