The NHS is set to take centre stage as the general election approaches. A recent BBC/Populus poll indicated that the NHS is regarded as the most important issue to be covered by the news with 93% finding it very or fairly important. Yet perhaps it is time that the NHS stepped back and allowed other issues to share the limelight. And I speak as an NHS manager.
Call me ungrateful, but I’m getting fed up of bailouts for the NHS. Over the winter period, for example, the government spent more than £0.5bn on hospitals who were struggling to meet targets. Yet pumping money into hospitals only provides a temporary solution. It serves to create a culture where firefighting is the norm and no thought is given to developing sustainable ways of working in the future.
So how do we move away from firefighting and begin to tackle the cause of the blaze? If demand on the NHS continues to grow at the current rate, there will be a £30bn funding gap by 2020. There has been little effort to address the problem at source. There is substantial evidence to suggest that social factors are one of the most significant determinants of ill health. A Canadian piece of research found that socio-economic factors accounted for 50% of health outcomes, with the whole of healthcare, incorporating primary, secondary and community care only amounting to 25%. This suggests there is the potential to make double the impact on health outcomes through focusing on social factors.
Let’s take deprivation as an example of how social factors determine health. There is clear evidence to suggest that those who live in the most deprived areas are more likely to suffer from poor health for longer. You could expect to live 69 years in good health in Surrey, compared with only 56 years in Manchester.
Clearly, the provision of healthcare only holds a fraction of the answers. Areas such as housing, employment opportunities and education all influence our health. Yet of course these are the preserve of the local authorities, who are facing unprecedented cuts which disproportionately affect some of the most deprived areas in the country. To take us back to our previous example, Surrey county council will enjoy a 3.1% increase in its budget for 2015-2016 whereas Manchester city council will face cuts of 5%, only serving to widen the gap.
The evidence is clear - the roots of the problems facing the NHS lie not within health but in the social factors that influence it. Yet I know from experience that this is far from the consensus view within the NHS. In a previous role, I had discussed the need to address the causes of ill health with a colleague. His response? “It’s too late for all that.” If the NHS thinks it can continue its firefighting mission and survive without help then good luck to it.
Compared to other areas of the public sector, the NHS is one of the few areas that has been relatively unscathed by cuts. Massive cuts in local authorities have forced change at an accelerated pace and scale. This has cultivated a degree of complacency within the NHS and a failure to recognise that it will need to look beyond itself for the answers. This is unlikely to change in an environment where NHS organisations know that they can count on a cash bailout whenever the going gets tough. I’m not advocating NHS cuts, though there is undoubtedly a need for health leaders to start thinking outside the box when it comes to the use of its money.
The cultural challenges faced by the NHS are reflective of broader issues. We live in a society that values quick wins and short-term solutions. Change that realises its impact over the long term tends to be overlooked in favour of targets and short-term gains. We naturally gravitate towards what is easily measurable over what counts, yet can’t easily be counted. Politicians, of course, pander towards this instinct. Targets make for better campaign soundbites than more complex and meaningful initiatives.
So what does this mean for the NHS? There are no easy answers. Indeed, the urge to find them is part of the problem. So first a plea – no more hospital bailouts – they do more harm to the system than good. There is not going to be a quick fix to the problems faced by the NHS. The change needs to come from within the system.
I would suggest that the NHS needs to look beyond itself to the agencies that influence social factors – to local authorities, the voluntary sector and community groups. The survival of the NHS depends on a commitment to working in partnership to tackle the causes of ill health. This is why I hope that 2015 will be the year the NHS will learn to share the limelight and that social issues will play a starring role in the upcoming election.
