Today, there are around 1.3 million people aged over 85 in England. That number is expected to double over the next 20 years. The baby boomers are ageing, and they’re living longer – but they’re not necessarily enjoying a longer period of good health. How should the health and care system respond to this demographic shift? Should it simply manage an increasing population of older people in declining health? Or should it work to increase the number of years of good health?
England’s long-term demographic trends pose many such questions for the NHS that should be addressed urgently.
That’s why one of NHS Providers’ post-election priorities is for the government to set out what the NHS needs to do to meet growing demand in the future. The NHS has already been overtaken by demographics, with a clear impact on patient experience and demand management. The series of transformation initiatives over the last few years is a testament to how we are playing catch up. A long-term view needs to be built into the DNA of the NHS so that we are always ready to serve future generations.
A long-term view must be built into the DNA of the NHS so we are ready to serve future generations.
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A key tenet of that long-term approach needs to start now: politicians must be realistic. In recent years, NHS trusts have been running to keep up with escalating demand, meet new government commitments, and turn their attention to transforming services. They have been asked to do this with historically low funding increases, with a significant funding gap to be made up through impossibly high efficiency savings. That circle can’t be squared.
Continuing as we are means that staff become unaffordable and hospitals become run down. It means patients cannot receive the right care at the right time. We need politicians to acknowledge that either the NHS is funded to meet NHS constitutional standards, or what is asked of the service must be moulded to fit resources.
We need politicians to acknowledge that either the NHS is funded to meet NHS constitutional standards, or what is asked of the service must be moulded to fit resources.
senior public affairs manager
An end to pay restraint
Support for the NHS workforce is the point on which the future of the service turns. Neglecting staff means neglecting patients. Trusts need to have the right people with the right skills being appropriately rewarded. NHS Providers has called for an end to pay restraint. Our workforce planning needs to be based on the demand that we expect, not the demand that we hope for. We need to give certainty to those who have uprooted their lives to work for the NHS, guaranteeing the right to remain of EU nationals.
Next, we can’t ignore the growing number of people needing mental health care. In most cases, mental ill health appears during adolescence. Support needs to be available early and close to home. The social and economic consequences of getting this wrong are profound.
Support for the NHS workforce is the point on which the future of the service turns.
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Yet the pathways for mental health care are fractured, creating difference in the cost and availability of care across England. This creates high levels of uncertainty for service users. Despite high profile pledges to reduce the number of children and young people with serious mental health problems being treated far from home, the rate of out of area admissions has risen from 57% to 69% over the last year. The way that mental health services are commissioned needs to be more joined up, with investment reaching the frontline. Mental health needs to be put on a fair footing.
We also need a better way for health and social care to work together. Their governance and accountability structures look at institutions not local systems, they are commissioned and funded differently, and there is no textbook or template for working together – every link and process needs to be built from scratch. While integration should be led locally, national leaders need to remove barriers to the evolution of services, and politicians need to give their support when changes are made to bring communities better care.
Social care funding must be urgently addressed
The spectre of social care funding must also be urgently addressed. After six years of cuts, over 400,000 fewer adults have received publicly funded social care. That doesn’t equate to 400,000 adults not needing social care. Much of that need has been transferred to the NHS, increasing the pressure across A&E departments, ambulance services, crisis mental health care and community services. England is facing a long-term social care challenge. There may be no politically palatable answer. But we do need an answer.
England is facing a long-term social care challenge. There may be no politically palatable answer. But we do need an answer.
senior public affairs manager
A significant step forward in arriving at that answer would come from changing how we talk about the NHS. The NHS must be alive to the relative buoyancy of its budget in a period of austerity. But equally, the NHS should be clear about the national wealth it creates. When we talk about local investment, skills and employment, social inclusion, and research and innovation, the NHS should be a proud and central part of those conversations. The NHS is at the forefront of world class care and is a major partner for the pharmaceutical and life sciences industries.
NHS Providers’ final call is for the value – not just the cost – of the NHS to be recognised. We must invest in the NHS as an investment in the UK.
This article was first published in the National Health Executive on 26 May 2017
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