Finding a cure for healthcare

Changing health needs

Over the last 75 years, societal shifts have, of course, led to significant changes in health needs, from increases in diabetes and cardiovascular disease, to greater awareness of mental health issues.

Within the next decade, more than a fifth of us will be over 65⁷ and may need more complex care over longer periods of time. Responding to these changing dynamics is putting pressure on a system designed for different health needs.

Funding constraints

Research by the King’s Fund⁸ shows that the NHS is particularly successful in providing access and protecting the population financially from the consequences of ill-health. However, while it is adept at delivering certain services – for example emergency care – other developed countries tend to deliver better outcomes in terms of treatment for conditions like heart disease, stroke and cancer.

Austerity measures, compounded by the Covid-19 pandemic and ensuing economic turmoil, have had a severe impact on funding and driven waiting lists to unprecedented heights. The NHS is urgently in need of solutions for its ageing infrastructure, lack of beds and limited equipment, and ways to keep up with rapid advances in technology.

The workforce challenge

With nearly 1.45 million employees⁹, the NHS is Europe's biggest employer, yet still faces severe staff shortages to meet ever-increasing demand. Around 8% of posts are unfilled, with many staff leaving to seek better work-life balance, creating a cycle of increased pressure on the remaining workforce. Relying on recruitment from overseas is merely a short-term solution¹⁰.

This has led to an increase in use of agency staff, with costs rising by 20% in 2021/22¹¹ year-on-year. These staffing challenges are further compounded by the current industrial action over the impact of staffing levels on patient safety, employee burnout and pay.

Health versus social care

The separation of health and social care from a policy and funding perspective over many decades has resulted in a mismatch between the two systems, with competing objectives and accountabilities acting as hurdles to truly integrated care.

The funding squeeze and under-resourcing of the care sector has led to high unmet needs, staff shortages, and services either struggling to provide the necessary care or closing, while there is debate about whether the latest reforms go far enough. These challenges exacerbate the barriers to addressing the care backlog.

Given the independent sector’s already significant role in supporting the NHS, there is perhaps a need for a more open and honest debate that acknowledges the extent of its involvement and addresses the obstacles to a more effective partnership.

An important part of this is improving understanding of what the private sector can offer, and the relevant funding pathways, within the NHS itself. It also requires an acknowledgement of the mistakes of the past.

With general agreement that the NHS is best placed to provide urgent and complex care, is there a broader role for the independent sector in specific clinical areas to meet our future healthcare needs? Where can the private sector work in true partnership with the NHS to drive innovation? Does the independent sector perhaps need to work harder to show where this works best and demonstrate that it is not a threat to the fundamental principles of the NHS?

An integrated planning approach that takes a more holistic and longer-term view would go a long way to improving our healthcare system’s ability to meet the nation’s needs. All stakeholders – including the independent sector – need to be involved from the outset. Surely there is an opportunity for independent providers to deliver much needed additional capacity or specialist centres of excellence for specific health needs to reduce elective waiting lists; however, this requires more certainty over long-term volume and funding.

Is there an opportunity for the independent sector to present a compelling offering for more complex needs based on evidence of better health outcomes? Does it need to be more ambitious about how it can support the NHS through managing the population’s health in the community, rather than managing the consequences of ill health in hospitals?

The NHS workforce is its greatest asset and there is an overwhelming business and moral case for investing in it – putting the workforce front and centre, and empowering those closest to the issues.

The recently published NHS long-term workforce plan represents an ambitious cross-party agreement to increase staff numbers through training, apprenticeships and international recruitment, as well as considering how to make the NHS a better place to work, improve morale and retain existing staff.

In the near-term, against a backdrop of ongoing industrial action, the issues of pay and workplace burnout can’t be ignored – nor the cost of agency staff to fill vacancies. There is certainly a need for better data on why staff are leaving the NHS to address the retention issue.

Longer-term solutions require longer-term thinking. Are our training quotas still fit for purpose? Is there a role for the independent sector in training junior doctors? Could pharmacists be given a broader remit to help ease the burden on GPs? How could the NHS and independent providers share, rather than compete for, the same talent? How can they use staff more efficiently and effectively? Perhaps by enabling staff to move between providers and gain experience of different clinical areas more easily, depending on demand.

Communication within and between organisations is key to delivering integrated care pathways and good patient outcomes. This requires a good understanding – at all levels – of services available, supported by the necessary systems, and a more holistic approach to planning.

Perhaps there is a wider role for the independent sector in managing pathways for chronic conditions, rather than discrete care episodes, to make them more seamless for patients.

Do we need to move away from the current tariff system towards a pricing model that better reflects the costs of managing a patient across the entire pathway? Is there a role for the independent sector to trial new approaches to connected care for specific vulnerable groups within the population? And how can med-tech help to provide a more seamless, single view of the patient?

A strong social care system is essential to reducing pressure on the NHS and freeing up hospital beds. Substantial reform and investment in social care is required to rebuild the care workforce post-pandemic, keep up with current demand, and accommodate the future needs of our ageing population.

How can we replace the existing fragmented approach to care funding with a joined-up approach between the NHS, independent sector and local authorities? How do we promote careers in social care to attract new talent to the sector? And how do we support the investment required to build new care home capacity?