Reflecting on 75 years of the National Health Service
On 5 July the NHS will celebrate its 75th anniversary. As part of the celebrations the NHS Assembly asked for insights from patients, carers and staff on key learnings from its recent past, as well as opportunities and challenges for the future.
Patient representatives from the Centre for Perioperative Care (CPOC) and members of PatientsVoices@RCoA were delighted to take part in this consultation. This blog summarises our collective thoughts on the three themes “where has the NHS come from?”, “where is the NHS now?” and “how can the NHS best serve people in the future?”, with a particular focus on anaesthesia and perioperative care.
We thought that a good starting point would be to look at the birth of the NHS back in 1948. The National Health Service was the first healthcare system to offer free medical care which was not based on insurance (that is the ability of individuals to afford it) but rather on the principles of equity and quality of care for all. Something to be truly proud of.
The benefits to the population have been huge – from vaccination programmes to advances in clinical care, which continue to this day. However much has changed since 1948 in the healthcare landscape. And it’s not just about technology and life expectancy, but much to do with patients’ attitudes to their own care and medicine in general.
The 21st century patient
The patient-doctor relationship has changed considerably. Although levels of health literacy can vary, today’s patients can be very knowledgeable and well informed about their conditions, as well as their rights as patients. All sorts of information on health, medications and medical conditions can be found by a quick scroll on a mobile phone, although some of that information is of questionable quality. Patients now organise themselves in online forums and chats to discuss their medical conditions and share experiences and treatments.
Do healthcare professionals need to be worried that they are left out of these conversations? Is there a risk that the divide between patient and doctor will become even greater? The amount of misinformation available on social media breeds an environment of mistrust in the healthcare profession and modern medicine – the vaccine hesitancy which developed during COVID-19 being a stark example of this.
The NHS and those who work within it must adapt in this changing world. Increasingly today’s patients don’t want to be told what to do about their condition. They want to play an active part in decisions about their care. Thankfully perioperative care gives a solid framework around shared decision-making through the work of CPOC, which brings together many different medical specialties with the aim of streamlining surgical pathways and patients’ outcomes.
This, we think, is one of the great advances in modern healthcare – the move towards a multidisciplinary and patient-centred care approach. It’s true that in some areas this is still work in progress, but the NHS is an enormous, and hugely complex, organisation. Just getting systems to talk to each other can be a challenge. The key thing is that these aspirations are at the heart of the NHS Long Term Plan and other devolved nations’ aspirations to make the NHS fit for the future. The NHS should never lose sight of these aspirations, as they will be critical to restoring people’s trust and their relationship with the healthcare system. Because ultimately what patients want is to be heard and to receive high quality, well organised care.
The challenges of the COVID-19 pandemic and health inequalities
When talking about the achievements of the NHS, we want to mention the response to COVID-19. As patient representatives at CPOC and the RCoA during the pandemic, we felt immensely proud and privileged to work alongside anaesthetists who worked incredibly hard to look after the sickest patients in critical care. However, the role of the anaesthetist during COVID-19 went way beyond this. Anaesthetists became leaders, teachers, innovators and organisers of care, earning them, in the eyes of the public and the media, a long-overdue acknowledgement of the critical role they play in the NHS.
As the NHS continues its recovery from the pandemic huge challenges remain, which go beyond the immediate urgency of bringing down waiting lists. Looking back to those founding principles of equity and quality of care, can we honestly say that access to healthcare is truly accessible to all? We don’t think so. And how can we tackle the stark health inequalities which have paradoxically developed alongside previously unthinkable advances in medical care? For example, a recent report by Diabetes UK highlights that people from South Asian, Black African, and Black Caribbean backgrounds are two to four times more likely to develop type 2 diabetes, despite years of investment and research into the condition.
The causes of health inequalities are complex and multifactorial, and solutions require a multi-sector approach. What the healthcare system and the NHS can do is to continue to innovate (while being mindful of not leaving less digitally enabled patients behind), to strive for better joined up care between health and care settings and to join forces with others in the prevention of ill health.
Anaesthetists and perioperative care physicians are increasingly taking a lead in this, but they cannot do so effectively without training, resources, capacity and adequate workforce numbers.
As the debate about the future of the NHS goes on, we will, through our renewed commitment to patient and public involvement, continue to work with and support the College, CPOC and its members by bringing the voice of patients to the conversation.
The NHS Assembly’s rapid consultation informed its recent report: The NHS in England at 75, which is available to download from the NHS Assembly website.