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The NHS winter crisis has been a struggle for patients and staff alike – but it has also sparked a much needed and long overdue debate about its sustainability and future.
There are those who believe – like former health minister Sajid Javid – that the way forward for a free cradle-to-grave service is to start charging patients who can afford it.
Shadow Health Minister Wes Streeting’s response to this suggestion was: “Over my dead body”.
3:38 Can the NHS survive?
Advocates of the NHS as a free service for all – including former Labor prime minister Gordon Brown – warn that this would create a two-tiered system that would fail the most vulnerable.
However, all sides agree the NHS needs reform and cannot be allowed to endure an endless cycle of summer and winter crises.
At its inception, the National Health Service was designed to serve a very different population. Today, thanks to advances in science and medicine, people are living longer.
But living longer doesn’t necessarily mean people are healthier – and an aging population, many with complex comorbidities, presents serious challenges.
Professor Kiran Patel, Chief Medical Officer at Coventry and Warwickshire University Hospitals, has provided advice on future health planning at a regional and national level.
“We can always say that planning could have been better, but we’ve been planning for many decades,” says Professor Patel.
“We know the population is aging. We know the public expects more, and we know that technology and digital healthcare are out there.” [in term of priorities]. “
Covid has left a long shadow on the NHS. We are still learning about the effect of the virus on our bodies.
We can already see its impact on patient waiting lists, which now number over seven million.
But Professor Patel argues that the legacy of the pandemic is not all bad.
“The pandemic has forced us to actually embrace a lot of that [new technology] And to start thinking more clearly in terms of planning not only services, but our workforce for the future as well.”
The issue of manpower is crucial. There are over 165,000 vacancies currently in the NHS.
Ambulance workers, nurses and hospital staff are striking for better pay – and will continue their industrial strike for weeks to come unless their demands are met.
They are burned out, demoralized, and feel undervalued.
Read more: The NHS in numbers Where – and why – there are long waiting times for emergency care Parents ‘constantly fight with the NHS’ over their son’s care
3:26 NHS hospital under stress
In November 2022, Health Secretary Steve Barclay outlined five short-term priorities for the NHS.
They were recruiting more staff for NHS 111 and 999 services, focusing on urgent and emergency care, tackling delays in discharge from hospital, improving access to primary care and investing in technology.
He was heavily criticized at the time by some health leaders for failing to mention the workforce crisis.
Labor’s Wes Streeting spoke after the first wave of healthcare strikes, and he had some powerful words to say about the future of our health services.
He said the NHS was in an “existential crisis” – and vowed his party would train more staff, use the private sector to cut waiting lists and offer fair wages and conditions for workers.
But he has also been criticized for outlining the opposition’s proposals for GP reform – saying a Labor government would “break the contract” with GPs and could make family doctors pay NHS staff.
2:53 Fee for GP appointments?
Sajid Javid’s proposal would see patients charge £20 for GP appointments and £66 for emergency visits without a referral. The idea would meet fierce opposition from doctors on the front lines.
Dr Ed Hartley, director of emergency medicine at Coventry and Warwickshire University Hospitals, will resist any moves to collect the payment.
He says that will not solve the crisis. Instead, he wants to see reform and investment in key areas such as social care and staff recruitment and retention.
“I want to see [extra funding] In social care, I want to see the right size of hospitals… We’ve lost thousands of hospital beds over the last decade, but we need to know the right number as a demographic.
“I want to see leadership of the system. So, I want to see the NHS working with local authorities, with community health providers, all to address the issues, and I want to see a long-term investment in the workforce.”
2:56 How the NHS crisis is affecting ambulances
Dr. Hartley says the additional funding will help solve many of the health services’ problems, but only if it’s directed toward long-term solutions.
He said: “Money in the right places is fixing the NHS. Short term projects – to put a holding pen for ambulances out of A&E – are not fixing the NHS. Short term projects to help buy some hotel rooms to care for home patients or patients who need to leave hospital are not fixing the NHS.
“Long-term investment in the workforce, long-term investment in the right size of hospitals, recognition of the care sector as a rewarding profession with progression, and presumably adequate pay, will go a long way to helping the NHS.”
From a major ongoing project about the future of the NHS, join our live phone show – NHS: Your Say – at 2pm. Call 020 8167 2200 and leave us a message giving you a chance to speak on the programme.
Tonight at 7pm there will be an hour long debate on the future of the NHS live from Coventry University Hospital, hosted by Anna Botting alongside a special panel.
If you are an NHS employee and would like to share your experiences with us anonymously, please email [email protected].
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