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ABHI at 30 Guest Blogs. The NHS at 70: what must happen next

There was considerable celebration this summer – even by the standards of a World Cup year – as one of the UK’s most cherished institutions, the NHS, turned 70 years old.

But we know from analysis published by the Nuffield Trust and others ahead of the health service’s birthday that, while it is doing well on equity and efficiency, it does poorly in preventing deaths from killer diseases such as cancer and heart attacks. We also know that waiting times are long and growing and that public satisfaction is slipping. So how can the NHS turn the tide in the coming years?

Well, the right political support will be important. Change takes time. We must avoid the temptation to reorganise (again); and Whitehall needs to back up what will be some tough decisions made even tougher because so much was made of the Prime Minister’s funding announcement.

After years of funding failing to match demand, that recent commitment to a multi-year settlement is a big step forward, even if it is less than was called for and less than historic levels of growth. This, and the high level of NHS vacancies and providers’ financial deficits, means we cannot expect too much overnight.

There is a £1 billion critical maintenance backlog facing hospitals, and we need to find alternative care for thousands of patients stuck in bed, while reducing the growing numbers of people on treatment waiting lists – now the sad reality for one in 14 people in England.

Regardless of what happens with Brexit, the NHS has an undeniable workforce crisis, with an especially glaring shortage of nurses and midwives and significant problems in general practice. Low morale and cultural issues need more than money, but we still need to bring back nursing bursaries for mature students who want to work in the community, while somehow finding a way to bring back the much missed experienced staff who have already left.

And the NHS cannot just be a service that treats ill people. Faced with an ageing population, it must do more to help people manage their own long-term health, so investment in public health is vital. Child health, on which we have stalled and now trail most other high-income countries, is a pivotal place to start. We know that kids leaving primary school are fatter than they’ve ever been, and that unhealthy kids inevitably bring those problems into adulthood.

There are undoubtedly interesting opportunities offered by video and app technologies, but this should not obscure what may be more significant gains from more prosaic improvements in existing data structures, the ability of systems to work together, decision support and the development of analytics.

Of course, such improvements will fall short if we don’t also find bold and enduring ways to fund social care, which has too long been swept under the rug. Under even greater strain than the NHS, it faces a further shortfall if Brexit cuts off access to vital staff. It will require political guts, but without a belated solution on how to fund long-term care – and systems like Japan’s offer pointers – the next 70 years of health and social care in the UK may not be cause for the popping of corks.

Nigel Edwards

Nigel Edwards is Chief Executive of the Nuffield Trust