Governments worldwide have taken varying approaches to the COVID-19 pandemic. In the UK, despite the outstanding success of the vaccine programme, there are many areas where the National Health Service has proven to be woefully unprepared. The fact that the UK has one of the highest COVID-19 death rates in the world is undeniable, and both grieving relatives and the British press are now demanding accountability for decisions taken by government to manage the crisis.
Ironically, this situation presents the government with a unique opportunity to address the failings of the NHS by establishing a Royal Commission, involving all major political parties and inviting participation from the devolved UK governments, under the suggested Chair of Lord Sumption (a person of requisite intellectual weight, capable of preventing the Commission from “taking minutes and lasting years”); this removes reform of the NHS from the realm of electoral politics, (previous governments having been reluctant to face any voter backlash that might accompany any significant attempt at true reform).
FUNDING
The Commission must consider how the NHS can be properly funded. The NHS is unable to meet even current standards of care with the money it has been given, let alone make any required improvements, and NHS spending needs to rise to 11% of GDP within 10 years.
The pandemic has highlighted the fundamental health problems created by an increasingly elderly population, along with the urgent need to incorporate social care into the mainstream of the NHS. Chronic staff shortages in both NHS and social care are endemic, and deep health inequalities must be also addressed – but all of this requires funding. While the past 10 years’ dismal per capita GDP growth is likely to continue, given the economic impact of COVID-19, successive UK governments have managed healthcare on the premise of an unspoken agreement with the public that expenditure (in the form of the NHS) must never diminish. All future funding should henceforth be ring-fenced in a special Health Tax to replace National Insurance (and cannot treated as fungible money by the Treasury). All other items of government expenditure must be covered from either general taxation or government borrowing.
PREVENTION BEFORE CURE
A major focus must be “Prevention before Cure”. Mr Hancock’s Feb 2021 White Paper on the Future of Health and Care is unlikely to obtain the necessary “buy-in” for success, and it is vital that adults take more responsibility for their own health, thereby avoiding the need to visit their GP in the first place. The NHS has been struggling with a horrifying rise in numbers of obesity, heart disease and diabetes patients since long before the appearance of COVID-19, and all three conditions have proved a significant factor in our extraordinarily high death rates. In Britain, 64% of adults are overweight, including 28% who are obese (WHO, March 2021); between April and December 2020, COVID-19 killed 1979 people in the UK with no underlying health conditions, while for people with underlying health conditions, there were 45,770 deaths (ONS data). Many dangerous health conditions are simply caused by bad diets, alcohol and tobacco – it is indisputable that the food we eat and the lifestyle we lead is making us fatter.
The Commission needs to:
a) study how other countries are improving their population’s health; and
b) consider how we can use the tax system to improve our health, e.g. taxes on sugar, tax offsets for gym memberships, etc.
It is, however, vital to ensure that measures to reduce obesity do not become an “attack” on the poorer members of society, there being a proven correlation between increasing BMI and low family income.
REORGANISATION/STAFFING
The NHS is regarded by the British public as a “world class” healthcare system, but their opinion is not shared by the outside world. It is imperative that we learn from other countries – France, Singapore, and Japan, for example, all demonstrate better health outcomes. Britain’s survival rates for cancer and cardiovascular disease remain alarmingly low and our current system is clearly not working in the best interests of the patient. The key to a successful outcome, particularly with cancer, is speed of diagnosis and treatment, and very often it is the length of time involved between seeing a GP, referral to a consultant, tests, diagnosis and hospital treatment that proves fatal. It is not the treatment that fails, but the scale of the bureaucracy required to obtain treatment. The potential for delay can only be exacerbated by the possible continuation of remote GP consultations (introduced via pandemic lockdown restrictions), wherein many diagnostic signals can be missed. The system requires significant change, but the Commission should not lose sight of the potential dangers here.
The NHS front-line hospital staff are its greatest asset and the key to delivering high quality care. However, operational staff shortages in both the NHS and social care are endemic, and action is urgently needed to tackle a vicious cycle of shortages, increased pressure on remaining staff and resulting stress/burnout, all sharply exacerbated by the Covid-19 pandemic.
It is evident that more healthcare staff need to be recruited and trained domestically to create a sustainable workforce (e.g. there are currently 40,000 nursing vacancies). The NHS, however, has 1.3 million full-time staff and is the largest employer in Europe, whereas Germany’s health service has far fewer employees but many more doctors. The Commission therefore needs to recommend an appropriate split between front-line operational staff and the administrative/managerial staff supporting them. It should also review the impact of part-time working on staffing rates, and the subsequent cost to the service.
CONCLUSION
Appointment of a Royal Commission to make recommendations for NHS reform in the following three most important areas:
• Funding requirements:
o Supporting an aging population (prolonged medical care)
o Merging physical and mental health care with social care
o Rising cost of new drugs/equipment
• Prevention before cure, i.e., individuals taking more responsibility for their own health
• Reorganisation/Staffing
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