A crisis situation creates opportunities for new beginnings and reinvention in ways that are rarely possible during ordinary times. What if this is true of the NHS? As doctors, we have a keen sense of just how unique this moment is. The current public health crisis and outpouring of social solidarity with the NHS present an incredible chance to reimagine how this glorious yet flawed institution operates.
This pandemic is forcing us to rethink how we deliver healthcare. For too long patients have experienced fragmented services, administrative hurdles and unreliable lines of communication. The “patient experience” often remains an afterthought in the NHS, leading to worse health outcomes, and costing the NHS dearly.
In a matter of weeks Covid-19 has shown us that change is possible. Traditional GP appointments have been supplanted with rapid adoption of video and telephone consultations, enabling vulnerable patients to safely speak to their doctor. Online prescriptions via the NHS app increased by 97%, including a huge surge in use by over 65-year-olds. Used intelligently, technology can increase the number of people using the NHS and their level of satisfaction with it, as well as improve care. This pandemic has reinforced the urgent need for updated digital systems, an end to paper notes, and centralised patient records for the UK. More ambitious technologies, such as using artificial intelligence to improve patient care, rest on getting these basics right.
What about those working in the NHS? Although frontline staff now enjoy the weekly applause of public appreciation, more will be required to repair morale, which hit rock bottom long before Covid-19. Concerns over working conditions plague the health service. Pay has continued to fall in real terms and, along with burnout and exhaustion, has led to unprecedented churn of frontline staff. Organisational culture remains a huge problem. A growing list of doctors have been punished for system failures or scapegoated by management. This suspicion of NHS management can make staff reluctant to speak up in the name of patient safety.
This crisis represents a vital opportunity to make the NHS a better place to work. Wellbeing and mental health initiatives have sprung up overnight to support the Covid-19 response, a vital drive that must become embedded. Creating a kinder workplace means modernising working patterns around work-life balance, treating staff with more compassion and improving whistleblowing practices. Pay cannot be ignored and must be addressed – nurses should not be struggling to cover their basic costs. If implemented, these changes benefit everyone, because healthcare organisations perform better when their staff feel valued, with improved patient satisfaction and superior health outcomes.
To make the NHS more effective, we cannot ignore politics. Major top-down reforms in 2012 transferred responsibility for public health outside of the NHS, making it the direct remit of local authorities. This change has led to significant under-resourcing of public health, with approximately £700m cut in real terms from 2014 to 2019, weakening national public health infrastructure and compromising our response to Covid-19.
The more the NHS is exposed to campaign promises and short-termist cycles of electoral politics, the less hope we have of a health service led by experts with a long-term view. Calls for an independent or cross-party commission for the NHS have gained traction following decades of government-mandated restructuring.
This pandemic has also brought a seismic shift in the public discourse around healthcare. For the last decade, the NHS has been described simultaneously as a beloved institution and a burdensome expense on the public purse. However, relative to other wealthy, western nations our healthcare spend is frugal. In 2017, the UK spent 9.6% of GDP on healthcare, compared to 11.3% in France and 17.1% in the US.
Incredible but necessary economic interventions by the chancellor, Rishi Sunak, have shaken the dominant narrative on public spending. The lesson the public is learning in real time is that money can be made available when it’s deemed to be important, and so the UK can continue to afford high-quality universal healthcare.
Finally, Covid-19 has focused our minds on the most important principle in health: prevention. Prevention is vital in a pandemic and in healthcare more broadly. The best way to treat any disease is to prevent it, and addressing risk factors is more effective and cheaper than medical management of a disease.
The vast majority of what contributes to human health takes place outside the four walls of a hospital. The greatest determinant of health is the social and economic environment in which somebody is born. If you want a healthy life, your postcode is arguably more important than your genetic code. In the UK, the poorest bear the brunt of ill health. Covid-19 exacerbates this trend, disproportionately affecting those lower down the socioeconomic gradient.
Prevention is where our resources and energy must be directed. In order to safeguard the NHS we must ensure we have robust public health and social care systems to promote health and prevent harm before it happens. Measures to improve socioeconomic conditions for citizens will do far more for our nation’s health than anything that happens within healthcare.
This pandemic will leave a lasting legacy. The NHS can be either a health system diminished by the strain it was put under, or follow a different path, where we harness this crisis for positive change to ensure the NHS emerges out the other side of this crisis transformed for the better.
• Joel Schamroth is a junior doctor based in London. This piece was co-authored by Salman Razzaki, who is a doctor working in digital health, based in London