Navigating the NHS, present and future: how might a future government respond?

The issues…

As the UK election results become clear on 5 July 2024, we also mark the 76th anniversary of the National Health Service (NHS). Described by Bevan as 'a great new enterprise', the NHS consistently tops the list of the UK's most loved institutions. Despite this, the NHS faces considerable pressure, with criticism and failings often highlighted in the media.

Reviving and supporting the NHS will be at the top of any government's first 100-day agenda. All healthcare systems face a host of challenges, the most pressing of which are pressing rising costs which no country can contain. of Great Britain spends around 11.3% of its GDP on healthcare, slightly less than Germany (12.7%), France (11.9%) and Japan (11.5%), and similar to Austria and Switzerland.

Technology and increasing multimorbidity are the main leaders of health care costs. Advances in technology increase costs faster than inflation due to new, expensive treatments, greater detection and higher demand. Multimorbidity (two or more chronic diseases) increases costs due to complex treatments and care needed. Multimorbidity is increasing worldwide at all ages and with aging populations. In England, the number of people with multimorbidity is designed nearly doubling from 19.2 million in 2019 to 35.3 million by 2049.

Labor shortages exacerbate these challenges. Health systems require sufficient health workers; services depend on their availability, accessibility, acceptability and quality. World Health Organization (WHO) RATINGS a shortage of 10 million health workers worldwide by 2030 NHS Long Term Workforce Plan highlighted an expected shortfall of 260,000 to 360,000 personnel by 2036/37. Absences lead to overburdened staff, longer wait times and compromised quality of care, potentially increasing costs due to inefficiencies and diseases missed at early stages.

The solutions…

Addressing these issues requires a multifaceted approach, and one challenge is one that must be prioritized. Headline figures, such as the 7.6 million people waiting for hospital treatment, will be important, but alongside this a more systematic approach may be needed. This is why four interrelated components must be considered together and simultaneously:

1. Improving care in community settings

1. Reinvestment in training and conditions for the workforce

1. Recognizing and supporting the value of unpaid carers and self-care

1. Development of economical technologies for independence

First, improving care in community settings through greater investment in community support, social and primary care, including out-of-hours care, is essential. The focus should be on those with complex conditions and multimorbidity who dominate service use and for whom early impact can be achieved. More services should be available after hours, not just bundled during regular hours. The involvement of local communities in the development of new models is vital. Supporting people with complex illnesses in the community can help hospitals focus on acute care, reducing waiting lists. Palliative care and some charities offer good models of holistic care and value for money, but are highly dependent on charity funding.

Second, increasing education and conditions for the workforce, especially in social care, nursing and other health professions, is essential. Making these occupations flexible, well-supported and attractive ensures a skilled workforce. In the context of multimorbidity, patients often visit multiple specialists, risking fragmented care. We need more clinicians who can work safely and confidently across all specialties and disciplines, putting the person before their illness. Rehabilitation offers significant opportunities and promoting independence should be a focus for all health professionals and policy makers.

Third, recognizing and strengthening contributions of self-care and informal caregiver support, transforming the patient-caregiver-professional relationship into a collaborative partnership is essential. Such transformation goes beyond education and tools, recognizing that people with chronic illnesses often have extensive knowledge about their conditions. Carers in the United Kingdom RATINGS that 6.4 million people in the UK provide unpaid care, worth £162bn a year in 2021 – around the total cost of the NHS. However, to date informal caregivers are rarely considered in self-care interventions and their role and needs are rarely recognized. A wider group of carers should also be involved, including volunteers and support workers essential to much social care.

Fourth, the advancement of 'saving technologies' is paramount. Developing cost-effective technologies that enable independence, maintain activity, and support health through home adaptations and AI can be helpful. Emphasizing 'lean' innovation in funding, training and partnerships is essential to focus attention on lower cost technologies and medicines.

Moving forward…

Health care systems must adapt to these changes, focusing not only on disease prevention, but also on recovery, health maintenance, and mitigating health declines with increasing multimorbidity. We need short-term progress alongside long-term investments in prevention.

To ensure the NHS is resilient, solutions and improvements a future government could consider include prioritizing health and social care in the community, investing in workforce development, valuing informal care and self-care, embracing technology frugal, all adapted to the realities of increasing multimorbidity and the evolving needs and preferences of the population.