The current NHS crisis is the result of repeated failures to overturn a broken model of healthcare
More short-term fixes will only lead to further crisis, and probable ultimate collapse, argues Adam Lent. It’s time for leadership to change the narrative.
Asked at Prime Minister’s Questions this week what he was doing to address the spiralling demand crisis in the NHS, Boris Johnson reeled off a list of measures:
- recruiting 50,000 nurses
- injecting an extra £4.5 billion into the health service
- and encouraging people to get their Covid booster shots.
No doubt, the PM sat down satisfied with his answer. The Conservative MP who asked the planted question certainly nodded along enthusiastically.
But behind the usual PMQ bombast, Johnson’s answer revealed the ongoing failure of governments of all stripes to get to grips with a health service whose frequent short term crises are symptoms of a much deeper problem.
Our NHS needs to promote ‘health creation’
That problem is no mystery – it has been pointed out repeatedly. Our NHS was designed primarily to make ill people well. But the number of people seeking out its services has kept growing. The consequent impact on the cost and scale of the NHS has gone way beyond what its architects could have predicted back in the 1940s.
Had they known the future, those architects would surely have designed a service far more focused on keeping people well rather than simply responding when ill-health strikes.
The job of policymakers now is to retrofit that ‘health creation’ role.
But as Johnson’s answer makes clear, there is still an overwhelming focus on short-term fixes. These are designed to bolster the current reactive model rather than shift the system towards prevention.
Covid should have been a massive wake-up call. Instead of regarding the pandemic as some freak storm that the NHS simply needs to weather, Westminster needs to recognise that the deep health inequalities that already scar this country have been exacerbated by Covid – piling yet more long-term pressure on the Service.
Equally, far from being a one-off event, Covid is merely the most severe example yet of an intensifying series of pandemics caused by environmental degradation. The NHS cannot continue treating the growing number of non-pandemic related illnesses it does alongside those infected by a growing array of novel pathogens without ultimately collapsing under the pressure of demand.
Short-term fixes and managing demand are not enough
There are two wrong-headed responses to this reality.
The first is the one pursued by Johnson: short-term fixes to keep a broken model limping along.
The second is to ‘manage demand’ by charging for NHS care or rationing services. This is an approach already being adopted by stealth, despite it running against the core principle of a universal, free service that is overwhelmingly supported by the population for completely sound ethical reasons.
The humane and only sustainable alternative is to make that massive shift to a model that prevents illness in the first place.
Thinkers like Michael Marmot and Nigel Crisp have detailed how that can be done. At New Local we are taking their ideas further by exploring what a community powered NHS could look like. So, the thinking is already done and being developed further.
Some of it is present in the recent NHS Plan and even makes its way into minister’s statements. But its adoption is all too slow, marginal, poorly funded and often ill-thought through given what we now know about the devastating impact of pandemics.
We need leadership on health prevention
What is desperately needed now is a party leader or senior politician at Westminster willing to change the narrative.
Someone courageous enough to break out of the shallow pursuit of headlines by announcing more short-term fixes to a broken model and instead educate the voters about the need for fundamental reform.
Until that person appears, the NHS will keep heading inexorably towards permanent crisis and probable collapse.
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