If history repeats itself, why is preparing for the future so hard?
As the NHS gears up to launch a new long-term strategic plan, with the newly ordained longest-serving health Minister at its helm, Maddy Farnworth explores what lessons the NHS might learn from the challenges it has faced in the past.
"We shall never have all we need. Expectation will always exceed capacity. The service must always be changing, growing and improving – it must always appear inadequate."
You'd be forgiven for thinking this quote comes from coverage of the NHS's current situation, as it faces an ongoing financial crisis, and an expanding workforce crisis. Dissatisfaction with the NHS is at its highest since 2007, and key performance targets are consistently being missed.
In fact, these words were spoken by Aneurin Bevan, founding father of the NHS, in June 1948. If a brief look at the NHS's history can tell us anything, it demonstrates that many of the issues the NHS currently faces have always been there.
As the Government and NHS England prepare a new vision for the NHS, they cannot argue that the future is hard to predict. Any new vision will need to anticipate rising levels of demand, growing expectations and the need to adapt to new and changing environments. If we do not learn from history, we are doomed to repeat it.
"We shall never have all we need"
Even if the NHS's 70th birthday gift meets all the financial demands (and that's a big 'if') resources will continue to be a problem. Workforce is increasingly being seen as a big a crisis as the money. Morale is reported to be at a record low, and vacancy rates are rising. In 2015, the NHS faced industrial action for the first time in 40 years.
Kenneth Robinson faced similar issues during his tenure: between 1964 and 1966 the number of GPs fell for the first time in the NHS's history and morale hit an all-time low. The General Medical Services Committee demanded talks on an entirely new contract of service. GPs in Birmingham publically resigned from the NHS. Negotiations were intense, but ultimately concessions were made on both sides. Here, perhaps, NHS leaders can heed the lesson of negotiation, and of compromise.
"The service must always be changing"
In the 1970s, Sir Keith Joseph was responsible for the first structural reform of the NHS since its inception. His reforms are credited with increasing the bureaucracy of the system with little improvement to the quality of services. They were widely criticised for their "remoteness" from the public. Sound familiar?
There are alarming parallels with recent NHS policy developments. The Sustainability and Transformation Partnerships (STPs) were criticised for their lack of public and clinical engagement, and the 2012 Health and Social Care Act is described in the IPPR's Interim Darzi Review as having "hindered high quality care rather than enabl[ing] it".
Reform is rarely popular, but sometimes necessary. Regardless, progress made since 2012 and in the Five Year Forward View should not be totally abandoned in any new long-term plan.
"Expectation will always exceed capacity"
With new issues comes new expectations, and new responsibility. The NHS of the past focussed on sickness, and on the hospital: not on prevention and community. This has already been recognised as unsustainable, as people expect, and new health challenges, demand a change. Shifting the health and care system towards prevention is no mean feat. The Government may struggle to find the best way to cross the bridge.
Lessons can be learned from Norman Fowler. In the 1980s, AIDS dominated health headlines. Fowler, despite encountering massive resistance from his party and then Prime Minister Margaret Thatcher, was the driving force behind one of the most controversial and powerful public health education messages of all time: don't die of ignorance. Following the campaign, new diagnoses of HIV, which numbered over 3000 in 1985, dropped by a third, and remained relatively stable until 1999. The power of being bold should not be underestimated.
The Health Foundation's Glaziers and Window Breakers, published following the 2015 election, describes the role of the Health Secretary, in their own words. For Jeremy Hunt, as he becomes the longest-serving health and social care Minister and the architect of the new NHS plan, could take Alan Milburn's advice, straight from the horse's mouth: "Buy time...the best political trick I ever pulled off was to publish a 10-year plan"
No doubt advice will flow from all directions. But as the Government and NHS England work on a new vision for the NHS in its 70th year, they could do worse than taking a look at the past to prepare for the future.
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