Read: The NHS - a celebration and an opportunity
The NHS is 75 years old this week and we should take a moment to think of all those who have worked in it in the past, and those that still work there today. In 1948 when it was founded, it was the first universal health system to be available to everyone, free at the point of delivery – a remarkable achievement. It treats over a million people a day in England and touches all our lives. It is what many people say makes them most proud to be British.
On a personal level, I spent 25 years working in the NHS, training at Barts Hospital and then working as a hospital and community nurse, working in respiratory research, working with a palliative care team and latterly with social housing providers. It was a real honour to be part of this fantastic organisation, alongside brilliant medical and non-medical healthcare staff. I learned a lot about the impact that high quality healthcare can have, not only on individuals but on families and their wider communities.
Fast forward to 2023 and there’s no doubt that the NHS is under enormous pressure - a combination of rising demand; an ageing population with more people living with more long-term health conditions; constrained capacity as a result of staffing shortages; and ever increasing public expectations of what healthcare can do. With the arrival of Covid in early 2020, what were once seen as winter pressures turned into all-year-round pressures for community services and hospitals across the country. This was felt especially in areas where increasing health inequalities place additional burdens on provision.
The impact is being felt not just in those services which have intermittently struggled to meet demand in the past but now in every area of the NHS. This is alongside a challenged social care system and a cost-of-living crisis which has affected both staff and patients. Many people are finding it difficult to see a GP, get the care in the community that they need, get an ambulance to go to A&E or to start treatment. This often results in slower access to diagnostic help and people get sicker in the meantime. The growing suffering from often unseen poor mental health is also taking its toll on people’s lives and work.
With the NHS one of the Prime Minister’s five key priorities, the Government has responded with its long-awaited NHS Long-term Workforce Plan, a 15-year plan with three key principles - train, retain and reform. It promises to double the number of medical training places by 2031, train over 24,000 more nurses and midwives a year and increase the number of GP training places by 50%. The Plan aims to keep up to 130,000 more staff over the next 15 years by modernising the pension scheme so staff can partially retire or return to work more easily but also by improving culture, leadership and wellbeing, giving staff more flexibility and investing in their professional development. Finally, the aim is to reform the NHS by taking advantage of the opportunities that new technologies like AI can offer, using technology so patients can recover at home. Additionally, expanding new roles offering a chance to progress, introducing more degree apprenticeships and recruiting staff from a far wider background aims to solve some of the workforce shortages.
These ambitions are welcome - and reassuringly practical - but it will be some time ahead when we can judge any outcomes. In the meantime, in our own work at the Purpose Health and Social Care Coalition, many of our NHS Hospital Trusts and social care partners are already exploring ways of tackling the recruitment crisis by attracting and retaining staff from their own communities, and by tailoring the service they provide to their particular communities. We have seen some fantastic leadership with teams committed to finding solutions to the challenges they’re facing. We have launched an advocacy campaign that aims to highlight that work, with a series of case studies that feature great examples of individual staff journeys within those organisations, including from Barts NHS Foundation Trust where I started my own NHS journey.
Our Health and Social Care partners also know that there is another crucial element to addressing the problems the NHS is currently facing, and one that looms large for health and social care organisations – the need to prevent illness rather just treat it. We need to encourage people to be more proactive about their health and wellbeing. There needs to be more education on the health issues that can impact their lives - and increase pressure on our health services – whether that is eating well, exercising more or not smoking. Organisations in the sector can make relatively low-level interventions that can make a difference, introducing monitoring and diagnostic services into town centres, for example, where they are more easily accessible and in areas where they are most needed.
90% of the public still want an NHS that is free and available to everyone but, according to the King’s Fund, just 29% said they were satisfied with it in 2022. So the message is clear – they believe in the service and its values but it needs to be improved so that it is fit for purpose. As we celebrate three quarters of a century of the NHS this week, there will be much discussion about how best to do that. It’s vital that we keep having those conversations – cross-party, with businesses and with third sector organisations. We need to listen to those who administer it, those who work in it and those who use it to deliver well-resourced, innovative strategies that keep pace with the changing health and wellbeing needs of the country.
The Rt Hon Anne Milton
