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The 70 year crossroads?

70 years of the National Healthcare Service (NHS) will be widely celebrated on the 5th July 2018!

I will be one of the many, extolling the amazing life saving work that is provided by this wonderful institution.

The difficult fact is however, our beloved NHS, dedicated to provide healthcare to all citizens, is slowly sinking under the weight of complex policy changes and underfunded services.

When it was launched by the minister of health, Aneurin Bevan, on July 5 1948, the NHS was based on three core principles:

  1. that it meet the needs of everyone

  2. that it be free at the point of delivery

  3. that it be based on clinical need, not ability to pay

These guiding standards continue to this day, yet a number of external influences effect the capability of the NHS to provide healthcare equitably to all.

As a recent Kings Fund report discussed the National Health Service is now more than halfway through it's most austere decade ever.

Every NHS colleague and provider will know this firsthand! Difficult decisions based on money vs. patient care have to be made and are made, every moment of everyday in their services. Somewhat undermining those original principles 1 and 3.

Figures from the World Bank also reflect the rapid decline in NHS funding;

In 2009, the UK spent 9.8% of its Gross Domestic Product on health care; by 2014, it fell to 9.1% or £176.8bn according to the Office of National Statistics (ONS).

The NHS Confederation further reports planned expenditure for 2017/18 as £123.8bn and in 2018/19 £126.2bn.

This abstemious funding pattern is expected to continue into the following years, against a backdrop of an average of approximately 4 percent a year rise (above inflation) in health spending requirement, and population expansion.

The UK is one of the lowest health care spenders among developed G7 countries. The US by contrast spent 17.2% of GDP on health care in 2017. Not to say that they have all the answers!

The ONS provides evidence that the majority of government expenditure on healthcare was on curative and rehabilitative care, which totalled £93.7 billion in 2015, or 63.7% of the NHS annual expenditure.

The NHS deals with over 1 million patients every 36 hours. (DoH)

With the UK population projected to increase from an estimated 64.6 million in mid-2014 to 69.0 million by 2024 and 72.7 million by 2034, how long can the system continue to support us?

A few innovative ideas have been tried over the last 20 years I have been working in these services, yet their adoption is seldom widespread or sustained beyond a commissioning cycle.

So the answer is yes, we are at 70 year crossroads, where major changes have to take place but with no magical solutions being presented.

We have to not only celebrate this platinum year, but consider the seriousness of our predicament. I suggest the government, providers and patients have to review all the options and decide.......

How to make the NHS not only thrive but survive?

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