Recently I got together with communications professionals working for a range of health policy-related organisations, including think tanks, professional bodies and charities. We each shared our plans around the anniversary – an array of events, publications and awards as we jostle for space on the NHS70 stage. We shared details of dates, scribbled our notes and then Charlotte Augst of the Richmond Group of Charities posed an important question: what do we individually or collectively want to achieve with all this activity?
To my mind, this birthday is a great opportunity to highlight the fact that public support for the founding principles of the NHS remains unshaken. But it’s also an opportunity for a national conversation about how the NHS needs to change now that, as a nation, we are facing a very different set of challenges to when the NHS was set up in 1948.
Otherwise there’s a risk that all this outpouring of love for the NHS – especially activities that portray doctors as ‘heroes’ who ‘rescue’ (largely passive and uninformed) patients – could end up reinforcing the status quo and blind us to how it needs to change and improve.
Wouldn’t it be ironic if the end result of the 70th birthday celebrations was to solidify resistance to change in the NHS? Just to be clear, I’m not talking about ‘tear-it-up-and-privatise-it’ sort of change, but the kind of change led by clinicians alongside patients and users that sees health services working differently to deliver better outcomes and stop people getting ill in the first place.
The problem as I see it is that – like so much of politics and debate today – the public debate can get stuck on a binary choice: either ‘heart the NHS’ (equated with protecting it from change) or ‘change the NHS’ (equated with risks of US-style privatisation).
But this is focusing on the wrong choice.
We need to move the debate on to a third option, one in which the founding principles of the NHS – free at the point of use, accessible to all and largely funded by taxation – are protected but there is fundamental reform in how health care is delivered and in how we promote good health.
Yes, this will mean changes to what hospitals do and where services are located. And yes, it will mean that we’ll need new professional roles, working in different ways – moves that can be seen as threats by the powerful professional groups.
There’s lots of consensus on the need for this change in health policy and leadership circles. I suspect I’m largely preaching to the converted here on The King’s Fund’s blog.
So how do we create a vision that is widely shared outside the world of health policy which describes this third option as a compelling and viable alternative? How can we engage the public in a conversation about how such a future would look and feel, and what their role in it might be? How do we listen to their ideas and work together to make change happen? And – as the Fund is exploring in its current work programme – what, in 2018, should be the ‘deal’ or ‘compact’ between the NHS and the public in terms of rights and responsibilities?
The winner of our essay competition last year on imagining a future NHS painted a marvellous picture of a time when local communities would celebrate the closure of a hospital as a marker of success in moving care closer to home and supporting people to stay healthy. This world is hard to imagine, especially given current pressures on hospitals, although our recent discussion events with the public have revealed that people recognise the need for more emphasis on prevention.
If we’re stuck in a world of binary choices, our challenge is to shift the debate to a different choice: ‘heart the NHS, but support it to change to better meet the health needs of the nation today’.
I hope that, along with the cake and tea parties and awards, the lasting legacy of the 70th anniversary will be an increased understanding of our health service and how we can both protect it and support it to change.
I attended a Conference for Health Workers in 2004 in Brighton where the Kings Fund gave a presentation based on a remit from the government "How can we change the NHS from a Sickness Service to a Health Service" I was inspired by this initiative then but have seen little progress since then. By now everyone should recognize that operating a free Sickness Service to the neglect of Health Promotion and Healthy Lifestyle Education will demand an exponential rise in expenditure , whereas to fund Health Promotion and Healthy Lifestyle Education at all levels from primary school to the training given at Medical Colleges will be sustainable and deliver a healthier population. The last attempt to demonstrate this in a pilot study involving over a thousand families was in the Peckham Experiment of the 1930s and 40s.