Professor the Lord Darzi of Denham, OM, is Paul Hamlyn Chair of Surgery at Imperial College and a surgeon working in the NHS. He was previously Parliamentary Under-Secretary of State for Health.
There is a well-spun narrative about the NHS – that it is a bottomless pit that swallows all the resources poured into it, virtually without trace, and waits for more. It is one that has been gloomily repeated for decades.
It is time to to transform this narrative. We should see the NHS for what it is: a wellspring that is the source of our health, the embodiment of our best values of compassion, generosity and equality, and the creator of employment, education, and wealth.
We cherish the NHS because for seven decades it has been there for us, offering care at our times of most basic human need. Social care is equally vital, preserving independence as people age, providing support to the vulnerable and holding communities together.
But that is not all. Over four million people are employed in health and social care, one in seven of the working population. British doctors and scientists discovered DNA, pioneered the first heart and lung transplants, and led developments in modern genomics.
Now we are now on the cusp of another revolution in robotics, artificial intelligence, and digital applications powered by the NHS’s unrivalled sources of data – in which British doctors and scientists are again leading the way.
It is vital that we stop approaching the health and social care system as a liability to be managed and see it for what it is: a tremendous national asset that not only enables us to lead the best lives we can, but which are also vital determinants of our economy.
As we argue in this independent cross-party Review of Health and Care, published this week, the life sciences sector employs a quarter of a million people, generating £64 billion in revenue each year and is estimated to have contributed 50 per cent of the increase in life expectancy in recent decades – a double dividend. Digital innovation and automation could bring productivity gains worth £12.5 billion a year in the NHS (almost 10 per cent of the budget) and £6 billion in social care. The UK is a magnet for would-be medical and care staff around the world, and could become a global hub for medical education and training.
But to seize these opportunities we must act fast. A decade on from High Quality Care for All, published in 2008, the system has been starved of investment and is undeniably under strain. Though quality has been maintained or improved – a remarkable achievement given the pressures, as revealed in my interim report in April – the years of austerity have taken their toll and access has declined. The stories are depressingly familiar: patients left on trolleys, operations cancelled, staff posts unfilled, deficits rising.
Theresa May’s government has belatedly recognised the need for a long-term funding settlement, though the Cabinet remains locked in dispute over the amount, with Jeremy Hunt reportedly lobbying for four per cent per annum growth in NHS spending, whilst Phillip Hammond pushes for closer to 2.5 per cent. Our analysis – taking into account a growing and ageing population –suggests that Hunt is much closer to the mark.
Absent from this debate is system change. All political parties rightfully recognise that a free at the point of need service is the right way to go. But a free NHS makes no sense without free social care. The divide between health and care is a fiction that can no longer be sustained. It is inefficient, unfair, and has led to justifiable allegations of a “dementia tax” at the last election, when cancer patients who have access to free NHS care were contrasted with Alzheimer’s patients restricted to means-tested social care.
Introducing free personal and nursing care for those with “substantial” and “critical” needs, would cost less than is commonly assumed – an extra £7.8 billion annually by the end of this parliament (over and above the funding required to properly resource the existing system). Though this is a large investment in the context of current social care settlement, in comparison to NHS spending its small, and Scotland’s experience suggest it can lead to a reduction in spending elsewhere, as care is shifted into the community.
On its 70th birthday it is obviously right to agree a long-term settlement to end the cycle of ‘feast and famine’ in the NHS. We call for the Government to return the NHS to its long-run funding trajectory, which would require growth of around 3.5 per cent per annum over the next decade. But to do this without properly funding social care would be a big mistake. Especially as both a generous settlement for the NHS and free personal care could be achieved for the rest of the parliament with just a one per cent uplift in National Insurance.
These are clearly ambitious proposals requiring investment and reform. Implementing them will be tough. But the prize is immense: a dramatic improvement in services, a boost to the economy and the renewal of our greatest national institution that still stands as a beacon for the world. This is vision worth fighting for.