The NHS £20bn boost is good news but the focus is too narrow for the long term

The announcement this week that NHS England’s budget will increase by £20bn over the coming five years should be seen as firing the starting pistol on a national debate on what kind of public health system (not just NHS) we want in the future.

The scope of the announcement suggests that this is not (yet) in the Government’s mind.

The hike (or gradual, slightly-below-the average-annual-growth-over-the-70-years-of-its-existence, increase) is aimed solely at NHS England. There is no additional money (yet) for PHE’s prevention activity; no rebuilding of funding for medical education under Health Education England; no mention of social care (despite Jeremy Hunt’s new purview across both health and social care).

These may or may not be addressed before the Autumn budget — but the Government has asked NHS England to develop a 10-year plan for the money (in effect “what can £20bn buy us within the current system?”); logically it’s hard to see how the NHS can plan to do any more than pump money into solving the short-term issues in the NHS that make uncomfortable newspaper headlines for Governments.

These problems relate to real people and real lives, so it’s important they are addressed (this announcement is good news in that respect); but this narrow focus obscures the real issue that the current system is unsustainable, built for a different age with a different set of problems; that propping it up is no long-term solution; and that talking about this announcement as providing the basis for long term planning and a ‘health service fit for the 21st Century” is at best missing the point and at worst wilfully ignoring it.

So what is the point?

The point is that, as well as rising health costs due to chronic illness and an ageing population (the root of many of the financial ills), there is also a huge amount of incredible innovation and rapid development in areas such as genomics, personalised medicine, medical technology, data and AI and understanding of the psychology of health that, taken together suggest the possibility of a radically different healthcare system in the future — person-centred, technology-enabled and developed to deal with the health challenges of this century.

At the Royal Society of Medicine’s Future of Medicine Conference last week some awe-inspiring developments were presented in many of the areas above, but the repeated question from the audience was: ‘who is thinking through what this all adds up to?’

In Beyond The Fog: A Positive Future for the Public’s Healthcare commissioned by the Royal Free Charity — and previewed at the conference — we have done exactly that.

Over 18 months of research and talking to leaders from across the healthcare landscape, we have described a potentially sustainable future system that for the first time integrates all of these ‘megatrends’ to create a system level view of a possible future for public healthcare.

It is by no means, complete — how could it be with a system so huge, so complex and in such a rapidly changing world?

But what we hope it will do is to build understanding of some complex issues among policy makers of all political hues, healthcare professionals across traditional silos and the wider public so that the real debate about the future of our healthcare system can start to take place.

With the right level of ambition and the understanding of new capabilities that will arrive at scale in the next 10–15 years, there is the opportunity to deliver:

• Transformational improvements in the nation’s levels of health and wellbeing
• A pathway to building a sustainable, integrated 21st Century public health and care system
• An engine for economic growth and social renewal

For far too long, the public discourse on public healthcare has been too narrow and too short term. That needs to change. This is not new news, plenty of people, including the House of Lords Select Committee on the Sustainability of the NHS last year, have bemoaned the woeful lack of long term thinking in public healthcare.

One reason for the lack of long term thinking is that there has been no vision for what a transformational project could buy. In this sense it’s not surprising that the Government has asked the limited question.

We, and our supporters, believe that Beyond the Fog provides a framework for describing the kind of system we want and need; and for starting to imagine the path to building it — but only if there is a massive level of ambition and collaboration in a major new national project to deliver it. A real desire to move from the pessimistic short-term focus on shoring up the old system towards galvanising the ambition and resources required to transition to a system that actually is fit to meet the challenges of the 21st Century.

In short, we hope to create a movement for long term thinking in public healthcare policy — to truly fire the starting pistol on a national debate on what kind of public health system we want in the future.

If you’d like to find out more and get involved at the start of something important, do get in touch at info@beyondthefog.org and join our email list here. We will be publishing the report shortly.

And if you’d like to help bring this initiative to the attention of others, please consider clapping this article and other posts on the blog.