The NHS at 75

To mark the 75th anniversary of the NHS, IHPN chief executive David Hare MBE highlights the proud tradition of partnership working between the NHS and independent sector, and talks about what the future may hold for both.

The NHS is one of the most cherished institutions in the UK, and July 5th?marks its 75th anniversary.

The NHS is something which we collectively as a nation feel passionately about. Time and time again, the NHS comes out at the top (or close) of the list of things which makes us feel proud to be British, and rightly so.??

Over the past seven and a half decades, the NHS has provided healthcare to millions of people, and it has played a vital role in improving the health of the nation.

The independent sector has always played an important role in the NHS. Since its inception, independent providers have worked in partnership with the NHS, providing a huge range of services, in every conceivable setting – whether that’s operations or surgery, diagnostic tests, outpatient care, acute care, mental health, or care in the community.

With the challenges facing the NHS today, I don’t think the independent sector has ever been so needed, so on a personal level, I was particularly pleased to be able to attend a special service at Westminster Abbey, which celebrated the achievements and accomplishments of staff. It was a really fantastic occasion, with so many staff - doctors, nurses, porters, managers - there. But also, I felt there was a real acceptance of the scale of challenges which exist, and a need for the whole system to work together to resolve them.

From time to time, I read pieces from opinionated columnists, claiming that the NHS is broken beyond repair – that it’s time to rip up the model and start again. I don’t have much time for those views, and neither do lots of our members – many of whom are both supporters, and crucially, partners of the NHS.

And the British public agrees – as the British Public Attitudes Survey made clear again this year, support for the principles of the NHS are as strong as ever – a universal health care system, funded from general taxation, free at the point of use.

However, what was stark in that same survey was just how low satisfaction with the actual service has fallen – it’s at the lowest level in over 25 years.

So, while pondering the future of the NHS and the healthcare system as a whole is becoming a perennial debate, it does feel therefore, like this significant anniversary is providing the backdrop to fundamental, existential questions like never before - certainly that was the sense I got from being at the recent BBC Newsnight Special, for example (see left).

Enormous pressure

There’s no question that the NHS today is under greater pressure than at any time in its history. No matter where you look – cancer, primary care, acute and emergency care, elective operations, diagnostics, finance – on nearly every measure, the struggle is very clear.

The workforce is on the edge. We’re seeing very low staff survey scores; clinicians retiring, emigrating or just leaving the profession. We’re in the middle of the most significant period of industrial action the service has ever seen. Public satisfaction with the service itself is at a record low. The picture is bleak.?

There are lots and lots of reasons why we’ve ended up here – some of them being global factors – but that’s for another blog (or a book perhaps). In terms of the fixes – these are probably even more complicated.?

From an independent sector perspective, the questions we have to ask, are what does this mean? What can we do? And married to that, I think there is a question for the NHS too – which is will it adapt, or partner with non-statutory bodies more openly than in the past, to ensure that all parts of the system are truly contributing??

There’s a clear cross-party consensus now emerging that the NHS should be ensuring more patients are treated in the independent sector. The?Prime Minister, Rishi Sunak, has been clear he wants to support patients to exercise their legal rights to choice, including getting their NHS treatment delivered by an independent sector provider, free at the point of use.

This call has been echoed by Keir Starmer, Leader of the Opposition, with both of the main parties now supporting a key role for the independent sector in frontline NHS care.

However, for some time we have been saying, informed by what members are telling us, that local NHS systems are still not engaging and not commissioning the sector to deliver work. There is capacity and capability in the independent sector which isn’t being utilised.

IHPN recently conducted a survey among our members, looking at engagement with the NHS planning process for 2023/24. 60% of respondents reported being asked by their local NHS to do the same?or less?activity as in 2022/23.

I understand the reasons. Of course it’s understandable that NHS trusts – themselves under extraordinary financial pressures – want to retain work.

However, we also need to ask – with 7.4m people on the waiting list – and with more than 300,000 people having waited more than a year – are we pulling out all the stops? Are we doing everything we possibly can?

Not a silver bullet, but part of the solution

Clearly, maximising the use of available independent sector capacity is not a silver bullet which can ‘solve’ the elective care backlog. I am certainly not suggesting that.

The independent sector is one part of broad range of policies needed to bring waiting lists down – just as it was in the 2000s, when it played a key role in tackling what were, then, record-high waiting lists.

And the independent sector can clearly have an impact now. To take one example –?ophthalmology, specifically cataract surgery, where the sector’s contribution has seen the biggest increase – is the only key specialty where overall activity levels are higher and waiting times are lower than pre-pandemic.

It might not be a perfect model, and there are certainly things to look at around how we ensure that training is delivered consistently, for example, but surely, with the scale of problems we are facing, we should be asking as a system – what are the lessons we can learn – for example whether a similar approach to doing high volume, low complexity procedures could work elsewhere.

It’s no surprise that with NHS waiting times at record levels and continuing to climb, patients are choosing to pay to get the care they need. The numbers of people having self-pay treatment have grown by 32% since 2019, with some very large increases in some specialties – for example hip operations, where numbers are up 152%.

The number of people using private medical insurance has also started to increase rapidly and insurers report growing numbers of people taking out policies.

A behavioural shift?

The longer that the challenges persist, and given their scale and complexity, we can expect to see continued demand for private care, and the market could grow significantly.

This is further shown by not just growth in volumes, but diversification of the private market. Private GP services are one of the big growth areas of the burgeoning private healthcare sector.

Again this reflects challenges patients feel they have in accessing their GP, and it’s undoubtedly been an area which has been turbocharged by the pandemic and those other related difficulties.

Private GPs are able to offer a high quality, flexible service, which patients welcome. As well as the ability to get an appointment quickly, they typically offer choice of face to face or virtual appointments, often out of hours, and both patients and clinicians value not being restricted to a 10-minute appointment as is typical in the NHS.?

The quality of service is an important factor. Our research shows that after experiencing private healthcare for the first time, many people say they will go straight to that option again should they need treatment, reporting both a speedy and high quality service.

The fact that more than 9 in 10 acute providers in the independent sector have now been rated ‘good’ or ‘outstanding’ by the CQC just goes to show how much the sector has improved and focused on the quality of its care. Patients can, rightly I believe, have greater levels of confidence now than ever before.

However, it’s also been interesting to see other research findings showing a relatively modest average spend by patients at the moment. This demonstrates that private healthcare is an option for smaller procedures, consultations, scans or diagnostics, so it’s not just about significant surgical operations, and may be more affordable than people assume.

It’s clear that people feel that the independent sector can help them, and we could be seeing the beginning of a significant behavioural shift with people feeling it’s perfectly normal and sensible to use private healthcare when they need it, in addition to, or separate from, their NHS care.

Throughout its history, the NHS has had to adapt and change to meet the needs of our society. While the challenges it faces today seem greater than ever, I still believe it can find a way back to delivering the timely, high quality care we all want to see, but it’s going to take sustained effort, investment and we have to be willing to embrace change and do things differently.

Whether the world around the NHS (especially patients’ habits and preferences for accessing healthcare) has changed forever, remains to be seen.