Over the last fortnight, the leaders of three important health sector organisations, NHS England, the NHS Confederation and the Foundation Trust Network publicly pointed some of them out - and we must heed their warnings. For all the good the NHS does, its 20th century infrastructure struggles to deliver 21st century healthcare and vulnerable people suffer unnecessarily. This does scant justice to the national health service our grandparents built; our generation must urgently equip it for the future. We can only do this if we get to grips with some hard realities.
Our society has changed immensely - and continues to change fast. Designed in the shadow of war to serve a smaller, younger, poorer and more stoic nation, today's system has wildly different demands placed upon it.
On establishing the NHS, Nye Bevan predicted that, after the first few years, the system would cost the taxpayer less because the population would become healthier. He could not have been more wrong. Its total annual budget has risen over a hundredfold from £437 million in 1948 (equivalent to about £9 billion today) to over £110 billion today, around 10 per cent of GDP. And people are arguably not healthier but unhealthy in different ways. Britain has the fattest young adults in Europe, for example, with over 29 per cent of women under 25 classified as being obese. Obesity, depression and dementia are all on the rise. Life expectancy has also risen by about ten years over the last 60 years so we see much more chronic disease, notably diabetes. Providing chronic care costs over 80 per cent of the NHS budget and some experts suggest that Type 2 diabetes alone will account for 25 per cent of its budget by 2025.
Over the decade I worked as a GP, during which I held tens of thousands of appointments, I observed a marked shift in patients' expectations and behaviour. I remember an 87-year-old man coming to see me dressed in his best suit, sporting military medals. He apologised for “wasting my time” before saying that he had crushing chest pain. I called an ambulance. Shortly afterwards, a 21-year-old woman arrived in her pyjamas, complaining of a sore throat. More generally, there are also increasing numbers of patients who make unhealthy lifestyle choices, and the baby-boomer generation, used to easier lives than their war-scarred parents, is coping less well with the pain of osteoarthritis, debilitating effects of stroke and other problems of ageing. On a mass scale, these social changes are boosting demand for, and cost of, health services.
At the same time, there have been remarkable advances in medical technology, surgery and drug therapy. All are welcome; but all have dramatically increased healthcare costs. New cancer drugs are particularly expensive, sometimes costing more than £50,000 per patient per year. A system like the NHS, which works on the principle of “the greatest good for the greatest number” cannot cope and the National Institute for Health and Clinical Excellence has already been forced to limit the availability of costly drugs.
Overall, the NHS needs to catch up with the changes in medicine and in our society. The chairs of the NHS Confederation and the Foundation Trust Network warned that "change to clinical services is coming – through effectively planned change or through unplanned and chaotic failure.” We can do better than this: this country could have the best healthcare in the world and preserve the important principle of access for all. This is why I became a doctor and one of the reasons I became an MP. But if we are to achieve this, there are four things we have to do.
The first is that we have to try to reduce demand for healthcare. Today's NHS cannot deal with the rising demand, so its survival depends on managing it. Among other things, our system needs to encourage more individual responsibility and to empower people to make wise choices.
Secondly, the NHS's ageing physical structures cannot be sustained. We need a plan for hospitals which deliver first class care across the country. In practice, this means building regional centres of excellence: hospitals with the best specialists and facilities located to serve at least 600,000 people. In tandem, it means enhancing community facilities in every urban centre to deliver chronic care close to people’s homes. Advances in telemedicine could push some of this into the home, but most of it will stay in the community - in GP surgeries and 'cottage' hospitals. Such a plan would cut the number of ‘acute’ hospitals and increase the number of ‘community’ hospitals.
Thirdly, we must change how we pay for healthcare to meet future demand. The NHS is not alone in facing a tough financial climate and other countries offer a range of options to test. Norway charges patients to see their GP and for routine tests. Germany has a compulsory social insurance scheme. France uses a means test. In Denmark patients are charged (at cost) for their drugs once a modest annual budget has been spent; only the terminally ill are excluded. We need to be open-minded.
Finally, if our health service is to last for at least another generation, then we need a new vision to take us into the future backed by a long-term plan which does not get blown off course by short term political cycles. Successive governments have tried to tackle some of the issues but avoid crucial change when it proves too complicated, big or potentially unpopular. We are dealing with politically unpalatable realities. So we need a constructive, informed, honest national debate which decides what the NHS is for, limits the state's responsibilities and helps to foster alternatives for people who do not want to be bound by them. We also need to build a political consensus and require an expert and cross-party group to work out how we bring our healthcare system up to date to deliver the best services for the country in ways we can afford.
No single political party, professional body, set of experts or interest group has all the answers - but each has some, and every person in this country has a part to play. For my part, I believe our country is uniquely privileged. We have inherited a first-class healthcare system and we live more comfortable lives than ever before. We must become better custodians of our legacy. To those who say this means: “Don’t touch the NHS”, I would answer that we do not have a choice. If we shirk responsibility and let our antiquated system collapse under the weight of demand, the vulnerable will suffer. I want us to secure our national health for future generations. But the health service of the future will not be the same as that of today. There is life after the current NHS - and it should be better.
Dr Phillip Lee is a practising GP and Conservative MP for Bracknell. Since his election in 2010, he has introduced a Bill to Parliament calling for the introduction of annual individual healthcare summaries itemised to list the breakdown of costs for an individual's care. He is standing for election as Health Select Committee Chairman.