Why We Need Radical, Transformative Thinking for the NHS By Dr Julia Patterson, Chief Executive, EveryDoctor The NHS has just experienced the most extraordinary challenge in its history. The pandemic has heaped enormous pressure upon a service which was already struggling to cope after a decade of government underfunding (during the 2010s, the real terms growth in health spending was the lowest since the NHS’s inception). As a result, both of cumulative underfunding and of treatment delays because of Covid-19, the NHS in England currently has waiting lists of 6.1 million patients. These are the longest ever on record. One might expect that in the face of such an extraordinary national healthcare crisis, the response from our politicians would also be extraordinary. Extraordinary funding increases. Extraordinary measures to support current staff and recruit new ones. Extraordinary efforts to transform the NHS into a service which truly fits the healthcare needs of the public in 2022. We might expect that having lived through a pandemic which has claimed the lives of over 150,000 people in the UK, healthulicare would (finally) be put front and centre of this government’s agenda. Sadly, this does not appear to be the case. There is much fanfare currently about proposed NHS funding increases, which the government plans to implement until 2024-2045. And yet this increase (which will amount to a 3.5% spending increase in real terms) is lower than funding increases in the 1960s, 1970s, 1990s and 2000s. In short, it’s a much more paltry investment than the government is letting on. As well as this lukewarm investment in the health of the nation, there is a Bill travelling through the UK Parliament at present called the Health and Care Bill. It is causing enormous concern to NHS campaigners, who believe that the Bill will accelerate NHS privatisation. The Bill involves fragmenting the NHS in England into 42 ‘Integrated Care Systems’, governed by Boards, which look as though they’ll be allowed to give seats to private healthcare providers. There is much discussion about Bill amendments at present, with campaigners and many politicians alike trying to remove the ability of private healthcare providers to occupy these Board seats. Whether or not this is achieved, the Bill has broader and deeper consequences for the NHS. It contains elements which will allow the Secretary of State for Health and Social Care to intervene in local services. It contains a worrying policy called “discharge to assess” which means that a patient can be discharged from a hospital before having an assessment from the services which will provide continuing care for that person in the community. And it’s bound up in difficult-to-decipher rhetoric which sounds progressive, but has seemingly little in the way of practical detail (the government’s Integration and Innovation White Paper which preceded the Bill talks of putting “pragmatism at the heart of the system” and claims it will “set aside bureaucratic rules”). The thing is, every NHS shake-up contains a great deal of bureaucracy. Old rules will simply be replaced with new rules. And it seems that this particular shake-up will remove some power from experienced local healthcare providers, and transfer it to the Secretary of State. Our current Secretary of State for Health and Social Care has no background in health. Neither did his two predecessors. It is unclear to many of us why a politician in Whitehall would presume to make better decisions for patients than a local clinician. The Bill is winding its way through Parliament, and at the time of writing (February 2022) is awaiting its third reading and a vote in the House of Lords. It may be voted down, and if so will then have to return to the House of Commons. But quite frankly, even with successive ping-pongs back and forth, tweaking amendments here and there, this Bill is simply the wrong Bill. It does not prioritise the welfare and support of staff who have endured the trauma of the pandemic and the incredible strain of working in an understaffed and underfunded workforce for a decade. It does not consider how that workforce can be buoyed up, grown and nurtured, to provide fantastic care to NHS patients in the decades to come. And it does not appear to tackle the enormous problems of inequitable care across the NHS, which disadvantage many patient groups. We desperately need a national conversation about the future of public healthcare in the UK. We need politicians to admit to the existence of NHS privatisation (which is embedded, and takes up around 7% of the annual budget in England). We need to think hard about the kind of NHS we want. And it is time, as we emerge from the acute phase of this pandemic, to think radically. The government needs to listen; listen to patients, listen to experts, listen to healthcare providers. It needs to scrap this Bill, and write a better one.