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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


The Telegraph The public deserves better than stealth NHS closures

Image The public deserves better than stealth NHS closures

Julia Manning, the chief executive of think tank 2020health on the need for a public conversation about the challenges facing the NHS

Simon Stevens, the chief executive of NHS England, published his "Five year forward view" on Thursday - a much needed explanation of the challenges that the NHS is facing and what can be done about them.

The prescription for treatment is roughly: revolutionising prevention; empowering patients and engaging communities. This plan really needs to be the start of a high-profile narrative for the public if we are to understand and judge how and why NHS services should change, and how we as individuals should respond.

The public’s frustration in recent years has been down to what seem to be ad hoc, disorganised changes by stealth to the NHS.

Downgrading or closures to A&E and maternity services in particular have punctuated the NHS landscape, with no clear sense of any overarching strategy or cohesive approach to what are still called “national” services.

The response to proposed changes has become stereotyped: health staff raise petitions, the public demonstrate and the local MP pronounces their outrage at the proposals, no matter what Party they belong to. The results are equally predictable: proposed changes are delayed whilst staff morale falls; some leave for greater job security elsewhere and the MP gets to keep their constituents on side. And in some cases, the local health economy continues to haemorrhage money and get further into debt.

Actually, this stereotype has persisted because no one has been consistently articulating the bigger picture of the pressures on the NHS: more, and older, people living with long-term conditions; expensive new technologies that have allowed us to treat and prolong more lives; demand from higher public expectations and from more lifestyle related disease.

This lack of understanding and no coherent vision for the future has left a vacuum which has largely been filled by scaremongers.

Social media is awash with predictions of the end of the NHS, the ‘Americanisation’ of healthcare run entirely by excessive-profit corporates, conflations of privatisation with the plurality of providers and partnerships within the NHS that the public appreciate (Macmillan nurses, WhizzKids wheelchairs, high-street opticians, pharmacists and hospices) and warnings of upfront payments for services. The public are both worried and confused.

There have been voices in the wilderness, trying to set out the choices before us. The Medical Director of NHS England, Sir Bruce Keogh, has been forthright, stating the need to ensure NHS services are fit for the future, emphasising safety and quality of care and the need for specialist services to be brought together.

He is absolutely right that for rare and serious illness, and for appropriate treatment for major trauma there needs to be a critical mass of experience and expertise.

Having suffered a major accident, we would all rather be picked up by a highly skilled ambulance crew with doctor on board and be taken to a specialist centre where they know exactly how to treat you, than by a routine paramedic and taken to the local hospital where someone may or may not have seen a similar injury before. If the footballer Muamba had not received immediate expert care and been taken past local hospitals to a specialist centre, it’s unlikely he’d still be alive.

Yet to take the public on a journey from the old 20th century NHS, built to care for infectious disease at a time when life expectancy was 66 years for men and 71 years for women, to a NHS fit for the 21st century, takes a coherent and determined narrative from the top.

Michelle Obama’s campaign on obesity is a great example of high profile, consistent leadership that has clearly communicated the challenges faced and changes required to the US populace.

Despite significant levels of agreement between UK politicians on core NHS issues, all we seem to get publically from MPs (when not campaigning against local closures) are accusations and counter-accusations of mistakes. Not only is this not helping people to understand the real issues, but it’s not exactly a modus operandi that is winning public support anymore.

The “Five year forward view” plan is a real opportunity to start a grown-up debate. I personally was really pleased to see how much of it reflected what our thinktank 2020health has said, particularly on local services in our “Go with the flow” report, showing how local hospitals can diversify and benefit from community support, and on the need to tackle obesity. Ebola might be more fascinating, but the real health threat to the UK is obesity, and in “Careless eating costs lives” we set out 17 steps to improve our obesogenic environment and obesity related disease.

As to the charge that many changes to A&E and maternity are financially driven, in a way many of them are, it’s disingenuous to say they are not.

There is a finite pot of tax funds for the NHS and we need to ensure the best possible value for money, which goes hand-in-hand with quality and safety. Raising more money will only work if the funds are very specifically targeted. But here’s where the mature debate needs to go: what are our priorities for the NHS, because like it or not we can’t afford to do everything. Who is going to take on that bit of the conversation with the public?