Why the NHS cannot be ‘fixed’


The government has just announced a plan to ‘fix the NHS once and for all‘. It is a bold plan focused on one of the main weaknesses of the health service – maintaining adequate staffing levels.

Whether the plan will work or not remains to be seen. We won’t know for a number of years. But the plan has largely been met with approval from all health care professional bodies. Unsurprisingly, the grouching has come only from the opposition for whom our political system makes feeding dissatisfaction their main role in British life – especially as an election approaches.

The government’s plan is welcome. Yet we also have to be realistic. Can the NHS ever be truly ‘fixed’? What does that even mean?

The issue with all health care services is that, however much money and resources are poured into them, they will inevitably be outstripped by ever-increasing demand. Health care technology continues to advance at a fast pace – for which we should be thankful. Yet it all comes at ever ballooning cost.

In addition, over time, people demand more interventions for conditions that, in the past, would have been considered trivial. We also demand that the NHS provides ever more intervention modalities. In some cases, you can even get a massage on the NHS these days.

The outcome is that demand for health care interventions is endless while supply will inevitably always remain limited. Given that, it is hard to see how the NHS can ever be ‘fixed’. It is always going to fall short of ever increasing public expectations.

Yet no politician seems able to say any of this openly and frankly. Maintaining the delusion seems to be preferable to some basic honesty. 

The conversation we need to have is this: given that demand will always outstrip supply, on what basis do we limit the scope of what the NHS can reasonably be expected to provide? Every health system in the world rations. They just do it by different means and some more transparently than others. It is a reasonable question for public debate.

The other canard that keeps being bandied about is that a greater investment in preventative care will save NHS money. This is reminiscent of Bevan’s idea that the “great and novel undertaking” that was the NHS would result in such an improvement in people’s health that healthcare expenditure would become automatically self-limiting.

This was one of the arguments put forward for funding the NHS through general taxation even though many in the Labour Party at the time objected to this approach fearing an ever growing public expenditure liability. Even though he won the argument on the day, Bevan was wrong; his colleagues were right.

Preventative care is, of course, desirable and has the potential to improve the number of years of healthy life across the population.

For that it is worth doing. But it will not save the NHS a penny.

It is also time to pull preventative care out of the responsibility of the NHS. Healthcare professionals are trained to treat illness. Preventative care is largely about lifestyle choices that can only be modified (slowly and painfully if at all) through a programme based on human behavioural knowledge, cultural memes, and changing social norms.

Healthcare professionals know nothing about any of that stuff. Such expertise is to be found among behavioural scientists, advertising agencies and others for whom this is their daily bread and butter. Medicalising preventative care and healthy lifestyles by letting them rot within an NHS structure that not only lacks the necessary skills but will inevitably (and rightly) remain primarily focused on treating illness is an utter waste of resources.

Preventative care needs to be moved out of the NHS and responsibility given to a new agency that can accumulate and deploy the skills and expertise appropriate to the task. This is extra expenditure – which may well be worthwhile. It will do nothing to modulate the inexorable rise in demand for acute treatment.

However healthy a life we lead, we will all eventually get sick and die at ever increasing cost to see us through our final year/s of life.

NHS reform is necessary and welcome. The government’s programme should be welcomed as a bold, if partial, attempt. But while the NHS can be improved but it cannot be ‘fixed once and for all’. And preventative care delivered by deploying the right skills is worth it for its own sake.

Nobody should be fooled that it will flatten the demand for NHS resources.

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Radix is the radical centre think tank. We welcome all contributions which promote system change, challenge established notions and re-imagine our societies. The views expressed here are those of the individual contributor and not necessarily shared by Radix.

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