6. The NHS at 60 ― what next?
Matter for discussion submitted by the RCN Sutton and Merton Branch
That this meeting of RCN Congress discusses whether the NHS has reached a birthday milestone or the age of retirement
Report on this discussion
Mike Smith of the Sutton and Merton Branch invited delegates to debate on the future of the NHS as it celebrates its 60th birthday. He asked if the NHS was fit for purpose or if the advance in health care will make it obsolete by 2068.
Philip McCaffrey said that people are healthier and living longer than ever before and that we should recognise that this is a reflection of the standard of care provided by the NHS.
The NHS is a “jewel in the crown of Britain’s public services” said Fiona Salter, but she recognised that debate needs to continue on how the current level of care can be sustained.
Delegates spoke of the need to embrace technological advances and to respond effectively to an ever growing demand for services. Maria Bryson from Essex said that the NHS needs to be dragged kicking and screaming into the 21st century.
It was argued that while it is important that sufficient funding is in place, it is also vital that resources are managed effectively.
Stephen Wright said that the NHS should be run like a business but not as a business and that there should be a return to the caring ethic that the NHS was founded upon.
Denise Chaffer proposed that nurses should lead the debate on the future of the NHS to ensure it is fit for the future.
Background
In July 2008, the NHS will celebrate its 60th anniversary. This is time to reflect on how the nature of nursing has developed over the last 60 years and to look forward to ways of ‘future proofing’ quality patient care in the NHS.
Health services provided under the NHS are funded from central taxation and are ‘free’ at the point of delivery. However, many health services are no longer routinely provided through the NHS, and there is a growing variance across the UK for NHS provision. The NHS is constantly centre stage in politics, indicating the importance in which it is held by the public.
Since the establishment of the National Assembly for Wales in 1999, successive Welsh governments have preserved the principle of a state-provided NHS, paid for by general taxation. There is an increasing policy emphasis on public health measures and community health care rather than hospital-based services.
In Northern Ireland, there remains a strong political consensus amongst all the leading parties in upholding and promoting the founding values of the NHS. The creation of an integrated health and social care service in 1972 was a significant landmark in the development of the service in Northern Ireland.
The Scottish National Parliament (SNP) government’s blueprint for NHS Scotland includes plans to reform the governance of the NHS and change the relationship of staff, patients and public to the organisation (Scottish Government, 2007). The SNP is promoting the concept of ‘mutuality’, which is intended to create a NHS which will remain in the public sector, co-owned by patients, public and staff.
In England, reform to the structure and finance of the NHS has led to a review of the means by which Government relates to clinicians. The Darzi Review is intended to consider the views of staff for the continuation of the NHS. The Prime Minister wrote to clinical staff on New Year’s Day and said, “I intend for this also to be the year in which we demonstrate beyond a doubt that the NHS is as vital for our next 60 years as it was for our last – more relevant to our future and the challenges that we face than ever before.”
Health technology and performance have changed dramatically in the last 60 years. How much does the history of the NHS hold as we move forward? How does the NHS remain true to its founding principles? Does a central taxation approach restrict opportunity for access to health care, or ensure the provision of central values of equity and equality and efficiency? Should we now change the direction of travel, and ‘retire’ the NHS in favour of a more 'modern' health system? What would this system look like, and how should it be paid for? Will there be an NHS in 2068? This discussion is intended to explore the future of a billion pound service.
References and further reading
Ambrose K (2007) Board’s eye view, Emergency Nurse, 15 (5), p.37.
Brown G (2008) Letter from the Prime Minister to NHS staff, 1 January 2008, Downing Street.
Scottish Government (2007) Better health, better care: action plan, Edinburgh: Scottish Government. Available from: www.scotland.gov.uk/publications (Accessed 4 February 2008) (Internet).