Reflecting on 75 years of challenges at the NHS


14th June 2023

The world’s second largest healthcare system – the National Health Service (NHS) has its 75th anniversary on 5th July 2023.

To commemorate this, our healthcare specialists gave their insights on various aspects of the NHS in the build-up to this landmark date.

First in the series is Bruce Potter, Partner and Head of Healthcare, who shared his thoughts of the NHS as it was at its inception and where it is today, highlighting some of its achievements to date and the opportunities and challenges facing it now.

Improved life expectancy, and a changing demographic

When the NHS was formed 75 years ago, life expectancy was shorter, in 1959 the average life expectancy was 69.69. The nation’s health was very different back then, and it’s a testament to how far healthcare has come during that time that now, in the UK, average life expectancy has increased to 81.77. This is truly worth celebrating, but with it comes the complexity and extra demands of an aging population, which was not there in the early decades of the health service.

The size of the population and its demographic make-up was probably the largest original challenge and is a continued challenge for the NHS.

Advances in medicine mean that more specialist treatments are available

Thanks to the enormous strides that have been taken in developing new treatments, the degree of specialist medicine that now exists is immeasurably greater than when the NHS first came into being. The range of treatments on offer within the NHS is impressive in itself, and a wider, specialist workforce has developed to support this.

Everything was a lot simpler in terms of the services offered in the beginning. The complexity of treatments and ailments has significantly increased since the 1980s and 90s.

The range of treatments now available for mental health, cancer and surgical specialities like orthopaedics is immense. This range will only increase with the degree of specialism and complexity of healthcare continuing to grow as healthcare advances.

As a result, patients have a much wider range of services to negotiate, and different specialists who are involved with their care. The interactions between the various specialisms within this new, diverse range of services can be difficult for patients to navigate.

Looking to the future, there is an opportunity for the NHS to continue to improve patient care by making it easier for patients to access the healthcare system, particularly as they get older and their needs become greater. Doing so will help relieve pressure on our modern, complex healthcare system.

Workforce

Workforce challenges are not new. In the early days of the NHS, having been converted from a wartime health service, certain levels of skill and care were there already so it had a good starting foundation. However, even then there were nurse shortages.

Over the years we have moved from a generalist workforce, optimised by the family GP, to the ultra-specialist professionals that we now need to have. The volume of activity that nurses and doctors now need to do has increased, as has the range of specialist activities that nurses are now trained for. Recruiting staff with the right expertise and specialisms is tough.

The NHS has tried various different ways of addressing the problem. It has provided significant training, and invested in attracting talent from other parts of the world. However, there is a global shortage of clinical workforce as highlighted in recent media reports.

The NHS has recognised that we have to change the way in which we look at the workforce challenge, and the NHS workforce plan will be critical to define and deliver change.

One way to address staffing is to alter the skills mix within the workforce, for example training nurses to add more clinical skills to their portfolios and other healthcare professionals to broaden their remit.

Another huge potential enabler which may help address the NHS’s workforce challenges is digital interfaces for patients. Using technology to make it easier to access and deliver care is a huge opportunity which we are certain to see being progressed in the near future.

The next few years are likely to see significant change as the NHS works hard to ensure it has the people and process in place which are needed to deliver the wide range of services it offers amid growing demand.

Rise in preventative initiatives

In Europe, there is a recognition that throwing more and more money at bigger and better hospitals may not be the way to improve the general health of the population. In the UK, the NHS now consumes a very significant part of the national gross domestic product. We are spending more money although if you look at international comparisons, not any more than the universal healthcare models of our peers.

This is why you have got everything from social prescribing – go out and have a walk, join the gym, provide a bike – to population health measures like diet control. The idea is to get things like heart disease and blood pressure under control at a population health level, and avoid hospital admissions. Using population health interventions, which are not just medical but social and environmental, is becoming increasingly important to try and prevent people getting ill in the first place.

However, there will always a need to provide healthcare, and the scale and associated cost of this is connected the to the size, age and complexity of the health conditions of the population. We are making great progress in medicine, and social prescribing and population health measures will play a part in helping keep our population healthy. As medicine advances however, we can expect to see additional budgetary requirements as the cost of medicines and other treatments continues to grow.

Innovative solutions

A different strand of healthcare is the interface with life sciences – we have seen how this can give us the ability to rapidly trial and develop clinical solutions, as seen graphically during the Covid-19 pandemic. Working with the life science sector has great potential to help us find innovative treatment solutions.

One particularly exciting area is the genomic basis on which future medicines could be individually developed. Of course, this will come at a cost and will require the NHS to transform its infrastructure (which is not currently designed for individualised or personalised medicines at scale), so it can deliver these treatment opportunities. This huge change is yet to be seen and but has the potential to be one of the most significant steps for the NHS in the next decade.

Advances in integrating care

Integrated care is a tremendous idea but it is still in the implementation phase rather than going full steam ahead.

There is a policy and care dilemma emerging between a very heavily medicalised US-type model – that has been the model for most of Europe – and more ‘in-the-community/out of hospitals’ models, where the improvement of the general health of the population is the priority.

An example of this model is seen in Japan. They do have big hospitals but also smaller community ones and get people back out of hospitals and into the community. We will need to look at how integrated care can help address the budgetary and structural questions about where we most need to invest, to help us adjust and adapt the NHS for the future.

Conclusion

Bruce concluded by stating it has been an honour and a pleasure to work within healthcare and witness the transformation that has taken place through the decades.

There will always be challenges but the strides made to date point to an exciting future. Blake Morgan are leaders in innovation and have collaborated on life-changing projects. We do not know what the future holds but given the pace of developments in medicine, it will be enthralling to see how the healthcare sector adapts and grows.

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