Keeping our NHS fit for the future

If we stand back now, the NHS may tip over the edge of its own ‘fiscal cliff’. Future health care services face serious challenges such as changing demographics (particularly ageing), increasing obesity levels and rising costs of new treatments and medicine.

To do nothing about the increasing demands being placed upon the system would be a political mistake.

I believe that the current infrastructure, and the widespread and relatively unchallenged acceptance of a service funded solely by the taxpayer, will lead to poorer patient outcomes than we should be achieving.

We have no choice but to fundamentally change the way this country’s health care is funded and delivered in the 21st century. As a politician and a medical professional, I am constantly battling with the challenges facing the NHS. There is a real need for consolidation of hospital acute services, to release funds which can help to improve the quality and performance of community care.

We have to make some tough decisions about future funding now, to ensure that the chronic and terminally ill patients of the future have the care that they need

Furthermore, I strongly believe and have argued on several occasions that health care costs, driven upwards by the inexorable increase in patient demand, have now reached a tipping point.

Any politician who thinks that the current NHS financing model and physical structure can be sustained in the medium to longer term is deluding themself. By doing so, they are exacerbating the trust problem that all politicians currently have with an increasingly cynical public.

It is time that politicians told the truth about the NHS: that the reality of health care provision in Britain today has changed, and will change even further over the coming decade. It is time to engage in an informed debate with the British public and then take the required action to save our universal health care service before it is too late.

As a GP, I have seen over 50,000 patients, and I am struck by the stark differences in behaviour developing between the generations. The stoic attitude of the post-war generation is significantly different from that of people born more recently. Behaviour has an impact on the conditions I deal with: when baby boomers hit their eighties after 2025, around 25 per cent of the NHS budget will already be spent on diabetes alone.

Without doubt, an increasing number of people in future will be getting prescription medication for conditions related to lifestyle choices. According to the NHS, over 886 million prescriptions were dispensed in England in 2009 at a cost of over £8.5 billion, a figure that is set to increase.

This is why we have to make some tough decisions about future funding now, to ensure that the chronic and terminally ill patients of the future have the care that they need.

As the 22 per cent of the British population born between 1945 and 1960 start drawing their pensions over the next few years, there is a real danger that the resulting costs will exclude younger generations from access to an NHS free at the point of use.

For our health service to be efficient and effective during these economically challenging times, responsibility for health care funding should be moving slowly away from the state towards the individual.

We also need to restructure our acute health care services, which will require district general hospital closures, consolidation of acute specialist services into larger, new ‘hub’ hospitals, and the building of new community clinics.

Changing the public’s mindset on these issues will be extremely painful politically, with no short-term reward – but we have no choice if we are to protect the fundamental principle of access for all. I want people to be free to choose any lifestyle they wish, while understanding its future health care cost implications.

I want to give more to the truly deserving because we have spent less on those who were perfectly able to provide for themselves. I want the very best 21st-century health care to be delivered in safe and appropriate environments.

If we do not persuade the public of the need for these changes, it is the truly vulnerable in our society who will be placed at risk.

Dr Phillip Lee MP is the Conservative Member of Parliament for Bracknell, and a GP in the Thames Valley Region. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.

To read further reflections from parliamentarians on the recent NHS reforms, download a joint report from the Nuffield Trust and The King’s Fund: The view from Westminster: Parliamentarians on the future of health and social care (June 2013).