The National Health Service in the UK was a model fit for a progressive, welfare state, and it has served its lofty purpose for the last seventy years as the country rebuilt itself from the ashes of the Second World War. It has reached a crossroads where the ideal of promising everything to everyone is no longer viable. A new ideal needs to be developed. One that can only be born from an honest, genuine, grown-up conversation of all political leaders with the people. In this real conversation, which needs to be collaborative, outside-the-box and genuinely transformational, the long-term health ambitions of the UK need to be dead centre.
As an outline, the country’s ambition needs to focus on health promotion from birth, or even before birth, the environment, the sustainability of the population’s quality of life and access to primary care using artificial intelligence and digital modality. Behind such a technology-driven model must be smart people with the right skills and aptitude supported by the appropriate technology. The current dependence on a traditional approach to working in mutually exclusive silos, as we do within professional boundaries, is outdated. It is the skill set that matters, not narrow professional boundaries. To make this happen, we need a significant overhaul of the professional regulatory framework.
The essential ingredients are there already. The UK has a singular professional regulation authority which has overarching control over the nine different regulators. This is where pharmacists working within community hubs can utilise their skills in deciding which pharmaceutical agents are suitable for different conditions, taking into account individual characteristics, interactions and tolerability. The doctors can focus on what they are trained for, which is synthesising a myriad of conditions to decide what the differential diagnosis should include, and which set of investigations should lead to the answer. AI can assist in this quest and is superior to a single doctor with limited experience in making a wide-enough diagnostic list. But all these are ideas for a long-term transformative look at the future of publicly funded health services.
There appears to be some truth in what the current Conservative think tanks suggest- an infinitely expanding funding envelope is not sustainable. Indeed, if any public polls are to be believed, there is no appetite for increasing contributions from national insurance or higher taxes. For the forthcoming decade, the UK economy cannot sustain much increase in health and social care funding. What can a much beleaguered Prime Minister with a limited mandate of fewer than two years do? It will be political suicide to start a considerable cross-party political conversation/ debate with the public on the future of the health service and social care.
Not to tackle the ‘NHS in crisis’ cries from every part of the health service would also be foolish. The series of strikes from paramedics, nurses and even doctors might soon make bad press. So, RIshi needs some quick wins. He has already taken the first step, initiating a dialogue with the rank and file. Being an astute politician, he is demonstrating his engagement with the professions but not the unions. In this way, he is addressing the rank and file in the profession but sticking to his party line of regulating and restricting the power of the unions. It is a tried and tested policy of divide and rule. Perhaps his desire to find an immediate solution is real, and one needs to grant him the benefit of the doubt. He has offered to be judged by his actions and, like all politicians, asked to be trusted.
Here are some immediate ideas for solutions:
Reduce the restrictive regulation for access to primary care by enrolling the over 300,000 doctors currently in non-consultant and non-GP posts into a temporary but new role in Primary care physicians. This will not threaten the GPs but will provide much-needed support to primary care services. These doctors should work within the Integrated care boards.
Utilise the autonomy of advanced nurse practitioners, district nurses and physician associates in managing their caseloads focusing on primary care services. The many hurdles posed by restrictive regulation should be rapidly swept aside.
Utilise the vast network of regulated community pharmacists in providing prescriptions to the public on previously diagnosed conditions, empower them to work closely with GPs taking on the choice of medication, the checking for tolerability and interactions. This infrastructure is already here and can be actioned exceptionally quickly.
The exit block from social care provision, which prevents hospitals from safely discharging patients into intermediate care, is the biggest challenge, not the availability of hospital beds. The social care model provided by local governments and councils is not sustainable. There must be reinvestment in adopting nursing homes, care homes and armies of hospital-at-home teams in every locality. These should work collaboratively with primary care and hospital teams and remain under the jurisdiction of the ICBs.
Finally, Rishi should talk to the people, extolling the virtues of health promotion, and healthy living and provide access to the vast network of public gymnasiums and encourage people to take on a regular habit of healthy eating and exercise. The local politicians and their staff in each neighbourhood can become exemplars of such schemes.
