The challenge today: NHS 75 and post pandemic
The Secretary of State for Health and Social Care gave a speech at the Centre for Policy Studies ahead of the 75th anniversary of the NHS.
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We gather here just a week before we will mark the 75th anniversary of the founding of the NHS.
There is much to celebrate: the NHS is treating more patients than ever before and using cutting-edge medicine day in and day out.
But we also must acknowledge that services face sustained pressure.
Much of this stems from the pandemic.
You only need look at the graphs showing the numbers of patients waiting more than a year for surgery before the pandemic to see its impact.
The virus left behind long waiting times for patients who had their care delayed or cancelled.
And it placed a huge burden on our NHS and social care staff, who responded with dedication and commitment.
But faced with these bigger challenges, we now need to be more open to the bigger opportunities for change COVID-19 has shown is possible.
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The Prime Minister has rightly made cutting waiting lists one of his 5 priorities.
Our 3 recovery plans reflect this absolute focus on delivery and chart a clear course to do exactly that across:
- electives
- urgent and emergency care
- primary care
I’ve been clear with the NHS that this is where I want its focus to be. And in return there will be fewer targets and less micromanagement from the centre.
Last week’s NHS mandate illustrated this point. A short and clear document that is half the size of previous years.
Cutting waiting lists is not just important for patients. It’s also important for the economy. People leaving employment due to poor health is increasingly a headwind for wider economic performance.
But there are signs of progress.
We’ve virtually eliminated 2-year waiting lists for elective operations like knee replacements, and reduced waits of 18 months by over 90%, showing that the NHS in England is on the path to recovery [political content removed].
We’re using technology to end the 8am rush for GP appointments.
We’re delivering 5,000 new permanent beds to get more patients into hospital, faster.
And in the coming days the NHS will be publishing the much-anticipated Long Term Workforce Plan.
This, for the first time in history, will set out our plans to recruit, retain and reform our workforce for the next 15 years so that it can better meet the needs of patients.
I’m driving the NHS to put patients first. Because too often our health system doesn’t.
That’s why we need to double down on giving patients more control over their care through initiatives like patient choice, and the work we’re doing to update the NHS App so people can access their medical records, manage prescriptions and sign up for clinical research.
The same principles should apply to public health and prevention - supporting people to make healthier choices throughout their lives.
Because it is in their interests to do so.
We need to give people the knowledge to understand their own health and the freedom to decide what’s best for them, the freedom to live their lives as they see fit.
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Outlook ahead
Demand for healthcare continues to rise.
The pressure on public finances is growing. Our population is ageing. And medical advances mean that more can be done.
When the NHS was founded in 1948, it had less than 145,000 staff and an annual settlement of £11.4 billion in current prices.
Today it employs 1.4 million people and has a budget approaching the GDP of Greece.
This means it delivers much broader, more comprehensive care than 75 years ago.
Indeed on a typical weekday, around 70,000 people attend A&E. Over 370,000 people attend an outpatient appointment. And more than a million people use general practice.
Yet demand is rising further still. From my experience working in the Treasury and elsewhere in government, I know that there are consequences if we were to allow the NHS budget to grow without control.
Two examples illustrate the size of the challenge ahead which makes action on prevention so pivotal.
One in 4 adults across England live with 2 or more health conditions.
And people over 70 are 5 times more likely to visit a GP than young people - and the number of 70 year olds is rising rapidly.
Most agree that prevention is the only way to bend this demand curve. But what I believe is that the only way we can do this is by giving people the tools to take more responsibility for their own health.
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Children warrant tighter controls
That sense of pragmatism means that I accept that on occasion government will need to intervene.
I am pleased there is a political consensus to reduce smoking, and steps taken over the last 13 years [such as on plain packaging] have made material progress.
And when it comes to our children there is a case for even tighter controls.
Take vaping. As Professor Chris Whitty, our Chief Medical Officer says: “If you smoke, vaping is much safer; if you don’t smoke, don’t vape, and marketing to children is utterly unacceptable.”
This is a pragmatic approach that this government is taking forward.
Smoking has long been recognised as the biggest cause of cancer.
And it’s right to encourage smokers to switch to vaping.
But it’s wrong that disposable vapes were being marketed to children when it is illegal to sell vapes to children.
As a dad of 2 young children, I know how frustrating it is when parents see products which are marketed specifically to attract children.
That’s why we recently cracked down on underage sales with our illicit vapes enforcement squad and why we ran a call for evidence on youth vaping.
We are looking closely at the evidence on the unknown long-term effects - and will be announcing further steps soon.
My choice
This is how I am approaching public health in my role as Health Secretary.
A deeply pragmatic approach that empowers adults and better protects children.
It is an approach that I know the Centre for Policy Studies has already championed, including through their paper on ‘Powerful patients and paperless systems’ with my colleague Alan Mak.
And it is the reason I have asked Rob [Colvile] for his input to the work that Professor John Deanfield is leading on a more personalised approach to prevention.
The opportunity
I want to give people the tools and knowledge to navigate the system quickly and effectively, being realistic about what works for busy people with busy lives.
We all know that family members sometimes put off going to their GP until symptoms have advanced - often for understandable reasons.
Balancing work and family life can be tough - and often your own health is sidelined.
That’s why we are making it much easier for patients to get the care they need at a time and place that suits them.
Starting new oral contraception with a trip to your local pharmacist, instead of needing to visit the GP.
Allowing patients to directly refer themselves to physiotherapy or podiatry for certain conditions rather than having to complete an obstacle course of appointments before being referred.
Giving patients access to their test results on the NHS App, rather than having to make another GP appointment.
And using the time freed up for GPs so they can deliver the high-quality care which we know they want to.
Simple, common-sense reforms that allow patients to tackle illness earlier.
This is exactly the mindset we need to approach prevention.
People in politics often talk about cutting red tape. In pharmacy that’s exactly what we are doing.
At the moment the rules say you cannot collect your medicine if the pharmacist isn’t there.
Even if they have bagged it up ready.
We are changing that.
The rules say they must deliver the exact quantities of medicines prescribed - so pharmacists waste time opening boxes and snipping up pill packs.
We are removing that burden.
The rules make pharmacists waste time supervising basic tasks and ban modern ways of doing things like ‘hub and spoke’ models.
We’ll change that.
There are lots of limits on what pharmacy technicians can do.
We are changing the rules to free up pharmacist time for patients - speeding up access to care and cutting waiting times.
Making it happen
Vaccination
The lesson from COVID-19 is that vaccination is one of the best value interventions we have to protect the public.
We are already seeing how innovation from our life science partners are applying this to prevention more widely.
Think about how the HPV vaccine is reducing incidence of cervical cancer.
Or hepatitis B for cancers of the liver.
And earlier this week the JCVI issued an update on the potential for new vaccines in RSV, a nasty respiratory condition which affects both babies and the elderly and which places pressure on the NHS each winter.
Looking forward our partnerships with both BioNTech and Moderna mean we may be among the first countries in the world to offer vaccines for cancers including melanoma and pancreatic cancer - personalised to the level of the individual.
Obesity
This personalised approach applies equally to tackling our other biggest healthcare challenges.
Take obesity.
We know about the health risks of carrying excess weight.
Obesity is the second largest cause of cancer and a major driver of heart attacks and strokes.
Of course, diet and exercise are important, but many of us struggle to lose weight and consistently keep it off.
The dieting industry has made millions out of our fluctuating willpower.
The solution in my mind is not to shame people into trying harder.
Or to attempt to revolutionise our society’s entire approach towards food overnight.
Instead, I want to build a prevention strategy which is resilient to the wider environment.
Of course, there will always be a need for initiatives to boost physical activity - such as our commitment to sports in schools
Or the opportunities provided by social prescribing.
As someone who played a little sport growing up, I understand the value - both physical and mental - that comes from playing a sport whether as part of a team or individually.
But activity alone is not a silver bullet.
That is why new treatments in obesity are so exciting.
In clinical trials, some have shown the ability to cut people’s weight by up to a fifth.
The technology is not new. But the way we intend to use it is.
Having been used by GPs and hospital doctors to manage type 2 diabetes for more than a decade, the way we intend to use it is - where we have put aside £40 million aside to pilot their use to manage obesity in primary care.
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Failing to roll out these medicines would not make sense for the individual, and it wouldn’t be in the interests of the NHS, which already spends £6.5 billion a year treating obesity and the conditions it causes.
I want to ensure that treatments of this type - which can reduce the burden and risk of serious health complications - are provided on the basis of need.
The health benefits matter in Hartlepool and Hastings, as much as they do in Harley Street.
Screening
And there is much more we can do to replicate this personalised approach.
Yesterday I was in Nottingham with the Prime Minister, visiting a lung truck in a supermarket car park which has been offering targeted screening for people who have smoked and are at an elevated risk of lung cancer.
The intervention has been hugely successful in turning late diagnosis rates on their head. Previously 80% of lung cancer cases were diagnosed late, now 76% are diagnosed at stage 1 and 2, when survival prospects are much better.
But it is based on a simple idea - focusing our efforts on those at higher risk.
Take maternity care - where we are exploring how AI can recognise patterns that identify mothers who may be at greater risk of complications when giving birth. This is important to patient safety in allowing earlier tailored support to better protect mum and baby where risks are identified.
My department is actively working on how we can use more pop-up screening and home testing - something we will look to have more to say on in the major conditions strategy which we will publish later this year.
And this is not just about loading more pressure and expectation on the NHS.
Quite the opposite.
I believe that early intervention can save us money in the longer run. But more importantly, early intervention can improve patient outcomes.
Closing remarks
Prevention should be at the cutting edge of healthcare.
It is among the most exciting parts of my job as Secretary of State for Health and Social Care.
[Political content removed], embracing technology and innovation, giving people the knowledge and power they need to make their own choices about how they live healthier and happier lives.