10 quick reflections on the NHS at 70

In the run up to the NHS’ 70^th anniversary in July, NHS Providers, NHS Clinical Commissioners, Royal College of Physicians, National Voices and Ipsos MORI convened a high level debate on the future of the NHS and care system. A panel of commentators and experts debated the central question: Can the NHS survive and thrive for another 70 years? in front of an audience of 250 health care professionals, patient groups, stakeholders and the media.

NHS Providers director of communications, Daniel Reynolds, pulls out the key themes to emerge from the debate:

1. The NHS may be at a watershed moment as it approaches its 70th but public support for the service remains unwavering. As panellist Ben Page, Ipsos MORI chief executive, told the debate, the NHS is the institution that makes Britons "most proud’". When asked the same question, Americans usually place their health care system at the bottom. Polling continues to show there is overwhelming support for the NHS’ founding principles – it is the one thing that unites Britons across political, demographic and regional divides according to Ben Page. And, despite the major challenges it faces, there was consensus among the panel that the NHS will still be here in 70 years time.
2. But a word of warning: political leaders should not take this support for granted as the public are slowly waking up to the pressures and problems facing local care services. The NHS as an issue has risen to the top of the public’s concerns, now outstripping concerns over immigration. As the British Social Attitudes survey showed, public dissatisfaction with the NHS has almost doubled in recent years. Our latest polling, carried out by Ipsos MORI, shows that almost half of the public (46%) expect the NHS to get "worse or much worse" over the next few years. Public opinion has yet to turn on the government over its handling of the NHS but, according to Ben Page, we may be close to the "tipping point".
3. Despite this high level of support, there was widespread agreement that how services are delivered to patients needs to change if the NHS is to respond to the major challenges it faces. These are well known – rapidly rising demand, an ageing population with more illness, the increasing cost of new drugs and technologies, and a workforce that is stretched to its limits. Panellist Dr Eileen Burns argued that we will not get the improvements to care quality that are needed without breaking down silos and integrating care services, as the NHS is now attempting to do. This includes major improvements to the way in which people with multiple long term conditions are cared for.
4. The likelihood that these changes will garner universal public and political support was recognised as being nigh on impossible. All the polling suggests the public find it very difficult to make trade-offs. According to Ben Page, the public abhor rationing – they want the same high-quality care to be free to everyone no matter where they live or their financial means. These are 'religious tenets' for the British public. Chair Nicholas Timmins said the government will need to find the "least unpalatable" way of satisfying the public, with tax rises "almost inevitably" needed to fund NHS spending increases in order to meet rising demand.
5. What the public are becoming increasingly clear about is the important role played by traditionally overlooked areas such as mental health, community services and social care. While care delivered in hospitals continues to grab the headlines, the public recognises that investment is needed in these other vital areas to provide better care in the community and in people’s homes, as well as to reduce pressures on hospitals and ambulance services. Our latest polling shows that mental health services were the second highest scoring priority identified by the public for any future funding increases. Community and adult social care services and children’s services also scored highly. This highlights a growing awareness of underfunding of mental health and community services – something that was strongly welcomed by panellist Polly Toynbee. Unfortunately, public health and prevention was identified as a much lower priority, reflecting that there is more work to do to convince the public of the critical importance of preventative initiatives.
6. Whatever decisions are taken by political leaders on the public’s behalf, it was felt that they must involve the public as well as staff. Panellist Anya de Iongh made a powerful case for patients and the public not to be treated as passive recipients of paternalistic decision making. They need to be fully involved in the big decisions – something that organisations such as National Voices and Healthwatch England have consistently advocated.
7. All panellists recognised the need for extra funding for both the NHS and social care to be delivered, with panellist Camilla Cavendish urging the government to end its short-term approach of pumping in "emergency bailout money" without a long-term funded plan. Both Polly Toynbee and Camilla Cavendish strongly disagreed with hypothecation as a means of collecting tax revenue, though Ben Page called it a "dishonest but highly effective approach". Asked to vote on this, the majority of the audience said they were not in favour of hypothecation.
8. The "devilishly" difficult issue of how to reform social care funding was identified by the panel as an issue that must be tackled hand-in-hand with the development of a long-term funding settlement for the NHS. Linking this issue to the need to make the case for potentially unpopular tax rises to fund more health and care spending, Camilla Cavendish said the challenge facing policy-makers is how to change the nature of the conversation and frame the issue in a way that wins support among the public. She cited the work of Adair Turner’s Pensions Commission which is widely credited as having taken much of the heat out of pensions’ reform before leading to significant policy changes.
9. A thread running throughout the debate was how NHS and political leaders need to do more to value NHS and social care staff. While Health Education England’s draft health and care workforce strategy was felt to be a good start, there was widespread agreement that this will not solve staff shortages and deteriorating morale in the next few years. Polly Toynbee in particular lamented the ending of the nursing bursary and the cap on visas for non-EU doctors which are resulting in rota gaps and delays in patient care. Above all, the government and national bodies were urged to do more to make the NHS and social care a more attractive career choice to ensure the next generation of doctors, nurses, allied health professionals, porters and other key staff are in place.
10. Finally, the debate brought together a range of perspectives from outside the traditional health policy 'bubble' to debate key issues of reform. There was welcome challenge about the lack of a strong patient voice at the heart of discussions about the NHS’ future, as well as the lack of people from black and minority ethnic backgrounds in leadership roles. It resulted in a better conversation. However, despite our efforts we were unable to secure a BAME speaker on our panel. This was a source of regret and something we will put right ahead of our second NHS at 70 debate in Liverpool on 25 July.

Watch the debate

Couldn't make the debate? You can watch the event in full below.