NHS at 75: We need a national conversation

Picture by Polly Thomas - Darren Hughes argues we need a national conversation on the NHS. The picture features people walking on the Footbridge in Newport.

Any major anniversary is a time of anticipation, celebration and reflection. 5 July, 2023, the 75th anniversary of the National Health Service, was a day to reflect with pride on all the NHS has achieved, how integral the service has become to life in the UK, and how we rely on it. We celebrated the lives it’s saved and the lives it’s helped welcome, what it says about us as a nation, and its people and how thankful we are to them.

There is much to be positive about, and NHS leaders are keen to seize opportunities modern and improving technology bring to deliver service transformation and, crucially, bring patients with them on the journey as they seek to improve care.

But this will need wider long-term support. The Welsh NHS Confederation’s report, launched to mark NHS 75 at the Senedd, outlines that we must use this opportunity to start a public debate about the health and care system of the future, detailing what this debate must cover.

We know the public have an enduring faith in the NHS and its founding principles of providing care to all, free at the point of need. However, our health and care services are not sustainable in their current form, with demand continuously rising. We won’t keep pace if we don’t have a whole-society approach to wellbeing and prevention. 

Access to healthcare only accounts for around 10 per cent of a population’s health; the rest is shaped by socio-economic factors.

On 5 July 1948, for the first time, hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella to provide services for those who needed them free at the point of delivery.

However over the last 75 years, the make-up of our population has changed dramatically. Average life expectancy of women and men in England and Wales has improved by more than 12 years – something to celebrate as a success.  

But an ageing population with increased frailty and long-term conditions brings with it fresh challenges. The NHS faces these challenges post-global pandemic, with immediate pressures impacting health and care services’ ability to plan in the long term.  

The NHS has a history of continuously adapting to respond to opportunities and challenges. Today, the NHS continues to drive innovations in patient care, none of which would be possible without the skill, dedication and compassion of NHS staff, as well as the many social care staff, volunteers, third sector, unpaid carers and communities that support the health and wellbeing of the nation.  

But this alone is not enough to ensure the sustainability of our health and care services for future generations, meaning the need for a national conversation has never been more pressing. It’s clear that demand on the NHS has long outstripped supply, with access to healthcare a major issue affecting huge swathes of our population. Unless we change the way we deliver and use services, the future of the NHS looks increasingly uncertain. Despite enormous operational challenges, the public’s unwavering commitment to the NHS should not be taken for granted.  

We must take this opportunity to co-produce and redesign services to ensure they better meet the changing needs of the population, so that services remain sustainable in the future. This includes the NHS supporting people to make decisions about looking after themselves and staying independent, ensuring they have access to the most appropriate care to meet their needs.    

But access to healthcare only accounts for around 10 per cent of a population’s health; the rest is shaped by socio-economic factors. Wales faces a significant number of population health challenges which stall life expectancy and widen inequalities and has the highest poverty rate among the four UK nations, with over a third of children (34 per cent) classed as living in poverty.  It’s estimated that health inequalities cost the Welsh NHS £322 million every year. Many of these are beyond the direct reach of the NHS. Therefore, we need to shift the focus to delivering public health initiatives to an integrated, cross-government, cross-sector approach. 

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Governments need to redirect resources towards preventative population health measures across all sectors, including employment, housing, education, transport and access to the arts and leisure. All sectors have a role to play in creating a preventative model and collectively we need to create the economic, social and natural environment in Wales to support good health and wellbeing in every aspect of people’s lives. 

Furthermore, governments must redirect resources towards long-term investment in public engagement and communication and provide clarity around what the public can expect, co-producing services with the service users themselves. This includes maximising the potential of digital solutions to bolster access and capacity.

And of course, we must not forget the NHS’s sister: social care. Social care has a crucial role to play in care pathways, both by enabling faster, safer hospital discharge and by keeping people out of hospital and in the community. Approaches to community care and timely hospital discharge are already diversifying, with multiple examples of local health boards and local authorities pooling resources to adapt to communities’ needs. But with deep cracks in the social care system, it needs appropriate, sustainable and long-term resource, including a sustainable workforce which has parity of pay with the NHS.

Without sufficient long-term funding, the service will struggle to reduce the scheduled care backlog, embed positive pandemic-era changes and make inroads in reducing inequalities by transforming models of care.

The health and care workforce is at the heart of service delivery, including volunteers and unpaid carers. As the biggest employer in Wales, the NHS has a huge responsibility to maintain and develop the current workforce, which is just as important as growing and training a new one.

But we need improved ways of working and planning for a sustainable and resilient workforce to meet demand. This includes identifying opportunities to develop skills in other sectors to help support population wellbeing.

The public wants value for money from the NHS and the rise in demand alongside constrained financial resources has made things increasingly financially challenging. NHS organisations need long-term financial certainty and recognition of the NHS’s contribution to the economy. We know that for every £1 spent per head on the NHS, there is a corresponding return on investment of £4. Without sufficient long-term funding, the service will struggle to reduce the scheduled care backlog, embed positive pandemic-era changes and make inroads in reducing inequalities by transforming models of care. 

It is not an option to continue on the current trajectory, with change needed now. We need an open and honest conversation with the public about what the future health and care service looks like and how we can shift from an illness service to a health service.

This must be centred on an NHS that is adequately and sustainably funded, an NHS that is taking care of people and their communities, an NHS that empowers and enables, and one that benefits from improving public health. It must be based on an ambitious and honest partnership between the NHS and those it serves. 

The challenge now is to seize the opportunity of the NHS turning 75 to unite behind a shared vision of the health and care system of the future. It is for the population and all sectors across Wales to ask what they can do to support the health and wellbeing of people now that will make the biggest impact in the future. It’s simply not an option to stay as we are – we need to think about the future now.

You can read the full report on the NHS Confederation website.

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Darren Hughes is the director of the Welsh NHS Confederation, the membership body representing the seven local health boards, three NHS trusts, Health Education and Improvement Wales and Digital Health and Care Wales. Our report calls for a national conversation on how we co-produce a health and care service for the future.

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