70 years of the NHS
In 1948, the NHS treated its first patients. Sarah Brealey looks at how far it has come and the challenges that lie ahead.
In a bustling part of central London, Barts Heart Centre offers state-of-the-art care in the UK’s largest such facility. It has the world’s biggest MRI centre, a temperature-controlled environment with technology to reduce airborne infection, and specially designed buildings with a high proportion of single-bed rooms.
Fifteen miles away, St Helier Hospital dates from 1938. The age of the building has led inspectors to say that services are not always delivered in an appropriate environment. There aren’t enough side rooms for infectious patients, or enough space between beds to meet national standards.
These are just two snapshots of the NHS, 70 years after it was launched by then Health Secretary, Aneurin Bevan. It’s a service that in many ways has transformed and modernised since 1948, but which faces significant challenges.
Improvements in patient care
Professor Ted Baker, Chief Inspector of Hospitals at health regulator the Care Quality Commission (CQC), started his first NHS job 45 years ago, as a lab assistant. He became a paediatric cardiologist and medical director before joining the CQC.
“Incredible progress has been made,” he says. “There are challenges, but we have hugely improved the quality of patient care. I get a sense the culture of healthcare is changing to one that is more driven by frontline staff. That’s a great achievement for a system under so much pressure.
The outlook for children born with congenital heart disease is fundamentally different from before the NHS
“Within my own specialty, the outlook for children born with congenital heart disease is fundamentally different from before the NHS. The expertise to provide specialist repairs to those with very complex heart defects has only been developed in recent decades. The BHF contribution to that has been very significant.
“The way we treat many diseases has changed completely. For example, angioplasty has completely changed the survivability of serious coronary heart disease in this country.”
Dr Matt Kearney, National Clinical Director for Cardiovascular Disease Prevention for NHS England and Public Health England, and a practising GP, also recognises the seven decades of achievements: “Think about antibiotics, statins, heart disease prevention, heart attack medication... But I think the biggest achievement is that the NHS has survived 70 years broadly intact in the way it was envisaged: as a free-to-all, cradle-to-grave service,” he says.
L-R: a microscope, a mid-century blood pressure monitor, and a stethoscope from the early years of the NHS.
Meeting changing needs
When the NHS was set up in 1948, it was part of a new welfare state designed to tackle the evils of “want, disease, ignorance, squalor and idleness”.
“Now, the challenges are very different,” says Mark Dayan, from health think tank the Nuffield Trust. “The battle against infectious disease is largely won, and the NHS has moved to tackle long-term conditions, specifically ageing.”
Professor Jane Dacre, President of the Royal College of Physicians, says this means a fundamental change in how the NHS operates: “When the NHS first started, people were dying quickly of a single disease: now they are living longer with multiple diseases.”
Professor Baker adds: “We need to adapt to meet the needs of this generation. The model of treating many of them in an acute hospital is probably wrong. We need to be better at looking after people in their homes and in the community.”
Dealing with mounting challenges
Pressures on the NHS always increase in winter. Last winter an unusually severe flu outbreak didn’t help. England, Wales and Scotland all recorded the lowest numbers of A&E patients being dealt with within the four-hour target since records began in 2010 (although Scottish figures did improve after December).
According to the regulator NHS Improvement, the NHS in England is short of 100,000 staff
“The picture of an overstretched, struggling NHS is an accurate one, unfortunately,” says John Kell, from the Patients Association. “It doesn’t have enough money, or an adequate workforce. It needed to redesign services years ago, when the demographic change we are now experiencing was on the horizon.”
An independent Commission on the Future of Health and Social Care in England (the Barker Commission), set up by think tank The King’s Fund, made its final report in 2014. The issues it identified – the separation between planning and funding health and social care, a lack of co-ordination between services and the need for more public funding – have not been addressed.
“The pressures are getting greater,” Professor Baker says. “We have seen unsatisfactory care of patients: delays being admitted to hospital, waiting in ambulances and long delays in being discharged. The whole system needs to work better together.”
L-R: a spirometer for measuring lung capacity, surgical tools and test tubes.
The impact of staffing shortages
Rising demand plus recruitment problems mean that getting enough staff is a major challenge for the NHS. According to the regulator NHS Improvement, the NHS in England is short of 100,000 staff. In Scotland, NHS staff made 4,120 reports of concern about staffing levels in 2016–17.
In November 2017, the Northern Ireland health regulator formally raised concerns about “the impact of the shortage of nurses on the provision of health and social care”. In September 2017, 82 wards were closed in English hospitals – 1,429 beds. The closures have been put down to staff and budget shortages.
Healthcare workers care about other people and want to do the best by them, and we need to support them to do that
Mr Dayan says: “More than one in 10 nursing jobs in NHS trusts doesn’t have an individual in it. That has implications for safety, on finances – because it costs more to hire agency workers – and on staff morale.”
A recent survey of 1,500 UK doctors by the Royal College of Physicians found 64 per cent believe patient safety has deteriorated over the past year and 93 per cent had experienced staff shortages.
“As a country, we haven’t made the right decisions about the level of investment and the staffing to keep the service going,” Professor Dacre says. “Healthcare workers care about other people and want to do the best by them, and we need to support them to do that. They are unsung heroes. It breaks my heart to see the pressure some of my colleagues are under.”
The NHS has been recruiting more doctors – but demand is also rising. The Royal College of Physicians has called for more doctors to be recruited from overseas, and for the government to give priority to healthcare workers from Europe.
Wales and Scotland have taken different approaches to tackling shortages. In August 2017, the Welsh government gave the NHS an extra £50m from its reserves to tackle waiting times, followed by another £10m in January 2018 to tackle winter pressures.