①When it was established, the National Health Service (NHS) was visionary: offering high- quality, timely care to meet the dominant needs of the population it served. Nearly 75 years on, with the UK facing very different health challenges, it is clear that the model is out of date.
②From life expectancy to cancer and infant mortality rates, we are lagging behind many of our peers. With more than 6.8 million on waitlists, healthcare is becoming increasingly inaccessible for those who cannot opt to pay for private treatment; and the cost of providing healthcare is increasingly squeezing our investment in other public services. As demand for healthcare continues to grow, pressures on the workforce — which is already near breaking point — will only become more acute.
③Many of the answers to the crisis in health and care are well rehearsed. We need to be much better at reducing and diverting demand on health services, rather than simply managing it. Much more needs to be invested in communities and primary care to reduce our reliance on hospitals. And capacity in social care needs to be greater, to support the growing number of people living with long-term conditions.
④Yet despite two decades of strategies and a number of major health reforms, we have failed to make meaningful progress on any of these aims. That is why the Reform think tank is launching a new programme of work entitled “Reimagining health”, supported by ten former health ministers. Together, we are calling for a much more open and honest conversation about the future of health in the UK, and an “urgent rethink” of the hospital-centric model we retain.
⑤This must begin with the question of how we maximise the health of the nation, rather than “fix” the NHS. It is estimated, for example, that healthcare accounts for only about 20% of health outcomes. Much more important are the places we live, work and socialise — yet there is no clear cross-government strategy for improving these social determinants of health. Worse, when policies like the national obesity strategy are scrapped, taxpayers are left with the hefty price tag of treating the illnesses, like diabetes, that result.
⑥Reform wants to ask how power and resources should be distributed in our health system. What health functions should remain at the centre, and what should be given to local leaders, often responsible for services that create health, and with a much better understanding of the needs of their populations?
