NHS - Fundamentally Different in 2020
1.1. Key Findings
The role and size of the NHS. The NHS will not be the same organisation in 2020 that it is now: Britain simply cannot afford to run such an expensive service. Private companies will become more involved in providing more care whilst the individual will be expected to take greater responsibility. The failure of persuasion means that government will be more likely to punish unhealthy behaviour.
Citizen participation. As a nation we treasure the NHS. As individuals we do not want to be involved in running it. We already recognise that perhaps our greatest contribution is in being as responsible as we can in our use of the health service. Our next contribution could come through joining a necessary but painful discussion on the hard choices surrounding long-term care and expensive treatments.
1.2. The NHS in 2020
Among our Delphi Panel of experts 75% expect that by 2020 we will still have a health service that is free at the point of use. That central principal is likely to remain – a view that is shared by all of the practitioners and experts we spoke with. However all of these individuals expect that there will be changes, including the introduction of a tiered system and payment charges for some services.
“There is no way that you can continue to tell people that the NHS is going to take care of all of their health needs.
Now that doesn’t mean a move to private providers; it means a move back to my mind of people taking responsibility. We need everybody to participate in trying to reduce costs to the NHS. Not going to A&E unnecessarily, being aware that we spend millions on people attending the Accident and Emergency Department who have had too much to drink. Not necessarily that people should be paying for their own healthcare but that if they start to use services unnecessarily they ought to contribute something towards them.” Dr Jonty Heaversedge, GP and Broadcaster
The above chart shows that UK consumers agree with Dr Heaversedge in that people should take responsibility for themselves before approaching the health service.
Opinion among our experts was divided on how the NHS will change but there was broad agreement on an increasing involvement of private providers of healthcare. This will have the effect of driving down costs through increasing competition. There will also be a greater emphasis on preventative care.
Most healthcare professionals we spoke to believe that by 2020 the NHS will not be able to offer the same coverage that it does now. Asked if she believes the government will legislate more on health by 2020, Dr Sarah Brewer is convinced that they will:
“The NHS as it stands cannot survive due to increasing costs of medical advancements and increased longevity in an ageing population.” Dr Sarah Brewer
With resources strained, some difficult decisions will have to be made on continuing expensive treatments for people with incurable conditions.
“...we need to have a better decision-making process on how invasive and interventional we are with people. At what point do we draw the line and say there is no point in treating you because you’re in the third stage of dementia or whatever else that you are suffering from. The only way to make those decisions on an acceptable basis is really to put it out to large numbers of people; to put it out to the nation even.” Dr Patricia Macnair, Medical Practitioner and Broadcaster
In part the greater desire to legislate has come from the failure of persuasion.
“Well I don’t think [the government] really understand it properly because we’re still getting old-fashioned public health campaigns telling people to stop smoking, eat the right things and generally beat themselves up instead of trying to empower them to make healthy choices. I don’t think [the government] even understand the basic sort of psychological science of trying to change people’s behaviour...” Andrew McCulloch, Chief Executive of the Mental Health Foundation
1.3. Citizen Participation – unpopular and unwanted
Our research shows that the vast majority of Britons are concerned about how the NHS is run. In an austere era of public spending cuts, albeit with health spending ring-fenced, those concerns are likely to increase.
The prospect of greater citizen involvement in the NHS has been raised in recent months as a means of making the service more accountable and involving the community.
Our research for this report indicates that only7% of respondents believe that it is very important for representatives of the local community to join health professionals in sitting on primary care trust boards.
The opinion among the experts we spoke to was generally (but not universally) against more citizen involvement.
“No – it is all kidology and hot air. Most people do not wish to be involved in the running of the NHS.” Niall Dickson, Chief Executive and Registrar, General Medical Council
“Citizens can play a role as consumers, in pointing out deficiencies and suggesting improvements. They should not, however, be involved in the actual running of the NHS. That should be left to healthcare professionals (there are too many non-medical managers already).” Dr Sarah Brewer
“Well, we’ve had various schemes for some time now to involve people more and I’m not sure how much uptake they’ve had, how much interest there has really been. And to be honest the more complex medicine gets, the more we have limitations on funding, the more that there are big, expensive treatments out there and we don’t have money to pay for them; the more we need some people who really know what they are talking about...” Dr Patricia Macnair, Medical Practitioner and Broadcaster
1.4. Conclusions
A majority of us value the NHS and expect it to continue to provide treatment that is free at the point of use. Yet, a majority of us do not want to be involved in running it.
The rising cost of the NHS will force a number of issues by 2020. Firstly a focus on preventative treatment. Given the failure of persuasion the government is more likely to legislate – curbing a range of behaviours to force healthier outcomes and reduce demand on the NHS. A voluble New Puritan group will support these measures, something that will encourage legislators. Secondly private companies will become more involved in the NHS than they are now. Their role may be in creating greater competition to reduce costs (for example through out-sourcing treatments). Thirdly citizens will have to take greater responsibility for their own health as less treatment is provided. This may take the form of paying for treatments that are currently offered for free, or greater take-up of private medical insurance. It may also mean the provision of individualised preventative measures.
That the NHS will be reduced in terms of scope is almost inevitable.
