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A problem of life expectancy


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Friday, 12 August 2016

A problem of life expectancy

You may have missed the NHS’s 68th birthday last month. It was a quiet affair.

Perhaps nobody felt much like celebrating after a horrible year which saw the junior doctors’ dispute, GP shortages, demoralised nurses, embattled managers, failing hospitals, missed targets, rows about staffing and safety, inspections, investigations and – as a consequence of all the above – more reviews, plans and initiatives than ever.

The hope of more money for the NHS was briefly plastered on the side of a bus. But the bus left and its jolly driver gave up buses and got a job abroad. The ever-depleting NHS coffers are earmarked for vulnerability, resilience, sustainability and support. Transformation, the bright side of this gloomy remedial treatment plan, looks increasingly wistful and irony-laden. 

The NHS finds itself like many a 68 year-old facing an uncertain future. What little money it has is all going on repairs, insurance policies that may not pay out, servicing debts and bailing out spendthrift relatives.  

This is the matriarch who has spent a lifetime looking after others but now suddenly finds her own health failing.

Her dependants have come to rely on her ability to weather a crisis, to bounce back. She wouldn’t abandon us now. It’s unthinkable.

We live in an age of unthinkables. Brexit, Isis and Trump to name a few. The death of the NHS is suddenly all too thinkable.

The obsession with financial balance provides a convenient cover for the fact that the current account is the least of our worries.

As Chris Hopson, the chief executive of NHS Providers, reminded us this week, the number of people living beyond 75 years will more than double by 2035.

The older population – that’s some of us now, all of us in future – accounts for two-thirds of spending in health and adult social care. Demand is soaring and funding is not keeping up.

The government says there is no more money. Leading health economists agree with Chris Hopson that there is not enough money. They may well both be right, but somebody has to be righter.

Transformation is the name of the eventual NHS in which there are fewer big buildings, more local services, better organised professional networks, cleverer IT, healthier people less likely to become ill and better able to care for themselves when they do, no corner shop general practices, a focus on people not conditions or institutions, personalised medicines, an end to third-class mental health care, and generous social care for the centenarian victims of our ever-increasing medical success.

The idea that changes of this magnitude can be squeezed out of either back-office costs or the pay bill is delusional.

Meanwhile the ageing population, obesity, mental health, broken social care and other pressures on the system are not going to wait patiently while we decide what we can afford.

If the answer is still no more money, then the question is: how much less NHS do you want?

Editor: NHS Networks