Health – a week for the pessimists?

As the election campaign stumbles back to life following the Easter holidays, this week has seen a pessimistic view of the NHS permeate the debate, as 140 health professionals signed an open letter to the Guardian criticising the coalition’s policies over the last five years. At a time when social media will play a bigger role in the election than ever before, it’s notable that a more traditional form of communication has helped set the agenda.

The letter pulls no punches – “Our verdict, as doctors working in and for the NHS, is that history will judge that this administration’s record is characterised by broken promises, reductions in necessary funding, and destructive legislation, which leaves health services weaker, more fragmented, and less able to perform their vital role than at any time in the NHS’s history.” Their solution? To repeal the Health and Social Care Act which they claim is “denationalising healthcare.”

The political debate is very much focused on the mechanics of the NHS and funding, often played out through the privatisation/nationalisation dichotomy. However, as we await the parties’ manifestos next week, a number of equally fundamental issues remain:

 

Prevention

To make the NHS sustainable and to improve public health, the political parties will need to get serious about the role of prevention, especially in an aging population.  The UN Food and Agriculture Organisation reports that 25% of the UK’s population is obese, compared to 15.6% in France, 17.2% in Italy, and 21.3% in Germany. With links to diabetes, heart conditions and respiratory conditions, preventing obesity improves health and saves the NHS much needed cash.

On incentivising good behaviour, the parties will look to nudge people into making good choices on the one hand, or at legislating on the other – the Conservative’s Responsibility Deal, and Labour’s criticism of it, shows just one area in which the main party approaches diverge.

 

Technology

All issues start from the issue of funding. Too politically charged to see an increase in taxation to fund investment in the NHS, all parties will need to look at the role of technology in getting more for less. Professor Christofer Toumazou from Imperial College London has argued that there are “megabucks” to be saved by using technology and data to shift the focus of healthcare towards prevention.  However, as the care.data debacle showed, there are pitfalls if data protection and consent issues are not taken seriously.

As well as the monetary benefits, technology such as telecare and telehealth would further personalise, and improve, patient care. The risks posed are around investing in untried and untested technologies;  the savings could be huge, but are the risks palatable to a risk-averse NHS?  And given Government’s record of technology briefs, who would champion the change?

 

Patients

The Conservatives have pledged to grant the public greater access to healthcare with 7-day GP surgeries by 2020, with patient power likely to be a theme in their manifesto. However, concerns from the profession could derail such plans. A British Medical Association (BMA) survey of 15,000 doctors found that 94% did not feel they could offer seven-day opening, with the BMA’s chairman Dr Chaand Nagpaul warning that “GPs’ ability to care for patients is being seriously undermined by escalating workload, inadequate resourcing and unnecessary paperwork.”

Once again technology and funding play a role. Would such a pledge inevitably lead to more consultations being carried out remotely? Will Labour’s plans to merge health and social care allow them to paint a better deal for patients, or will their focus on structures and process be viewed as institutional navel-gazing?

 

Innovation

Finally, will the parties focus on life sciences? Professor Sir John Bell, a former President of the Academy of Medical Sciences, has recently spoken-out against the City’s lack of interest in life sciences, arguing that UK industry is too dependent on GlaxoSmithKline and AstraZeneca.  George Osborne’s final Budget of the Parliament provided nuggets for the sector, but will the debate shift from health as a cost to health as an investment? Like technology, this is unlikely to get significant airing in next week’s manifestos, despite its importance for healthcare in the UK.

The NHS is often a debate about numbers – funding, nurse and doctor numbers and targets hit or targets missed. However, for parties wanting to improve, or just maintain the NHS, they will have to grapple with some of the wider, long-term themes.  Funding and structures should not be the only shows in town.