This July, the UK’s National Health Service (NHS) turns 70. A global pioneer in publicly-funded healthcare provision and the jewel in the crown of the post-1945 British Welfare State, the NHS is revered domestically and internationally as a symbol of social equality in practice.
Yet providing universal free care at the point of delivery has never been easy. Just as it has been responsible for some of the great breakthroughs in public healthcare provision, the NHS has also fought a continuous battle with funding, resources and structural organisation.
In 2018, as it enters its eighth decade, the challenges faced by the NHS are as stark as ever with budgetry pressures caused partly by an ageing population presenting with ever more complex care requirements.
A landmark anniversary is as good a time as any not only to celebrate the achievements of a great institution, but to look forward and ask what it will need to thrive for another 70 years.
A revolutionary idea
Innovation is part of the DNA of the NHS. Its very inception stemmed from a revolutionary idea – to provide free healthcare for all at the point of delivery, overcoming barriers of wealth and location.
To say it was decades ahead of its time is no exaggeration. Access to basic healthcare was affirmed as a fundamental human right by the World Health Assembly in 1978, exactly 30 years after the NHS was launched.
It wasn’t just its principles of social equality that were radical, either. The NHS pioneered the unification of public healthcare services into a single entity, drawing together hospitals, general practitioners, pharmacists, opticians and dentists. One of its biggest innovations was the replacement of a mish-mash of funding from private, charitable and local authority sources with single revenue stream through taxation.
As Aneurin Bevan, the Minister of Health credited with masterminding the NHS, put it: “This is the biggest single experiment in social service that the world has even seen undertaken.”
A history of innovation
Illustrating how innovation and pioneering work in healthcare has been part of the heritage of the NHS from the very start, the UK has been the source of numerous medical firsts ever since its launch.
In the early years of the NHS, research undertaken by Sir Richard Doll and Austin Bradford Hill while working at the Central Middlesex Hospital demonstrated the first links between smoking and lung cancer. A number of vaccination programmes were pioneered in the first decade of the NHS’s existence, including for feared killer diseases polio and diphtheria.
In 1962, the world’s first full hip replacement was carried out by Prof John Charnely at Wrightington Hospital, Lancashire. In the spirit of continuous innovation, Prof Charnely famously asked patients if he could recover the prosthetic hips post-mortem, so he could examine them for wear and tear and so improve the design.
Further NHS firsts included the first CT scan in 1972, and the birth of the world’s first ‘test tube baby,’ Louise Brown, in 1978. This pioneering work on IVF fertility treatment opened the door for more than one million babies conceived since.
As well as fuelling innovation in medical science and technology, the NHS has also played a major role in changing social attitudes to health and health care.
In 1957, the Percy Commission advised that mental health conditions should be approached in the same way as physical illness and disease. When adopted as part of the Mental Health Act two years later, these recommendations ended decades of arbitrary detention and incarceration for mental health patients, paving the way for work to increase understanding and improve treatment of mental illness that is ongoing to this day.
Similar steps forward in public health have included the introduction of prescriptions for the contraceptive pill in 1961 and the subsequent legalisation of abortion in 1967, and the ban on smoking in public places in 2007.
The burden of success
For all the revolutionary thinking and creative innovation that has shaped the NHS over the past 70 years, one conundrum that no one has been able to resolve adequately is how to organise and administer such a massive organisation efficiently so budgets are kept under control.
In many ways, the NHS has been a victim of its own success. On average, men and women in the UK now live 14 years longer than they did in 1948, while infant mortality rates have dropped from 36 deaths per 1000 births to just 3.9. That has resulted in an inevitable rise in population – there are now 15 million more people to care for than when the NHS was founded.
But just as importantly, the demographic of the population has changed. As well as improvements in infant mortality, the eradication of childhood killers like measles and diphtheria has shifted the balance of the population. Longer life expectancy means more people are living to experience the complex health issues that often come with old age.
These facts partly explain why there are now more than ten times the number of prescriptions issued each year than in 1948, and why the annual NHS budget has increased from the equivalent of £15bn to £116.4bn.
No one is under any illusions that those kinds of increases are sustainable. Organisational change has been a near continuous feature of the NHS throughout the past 70 years. Yet no structural reforms have been able to bring spending under control.
This will continue to be the major challenge facing the NHS long term. So what is the answer?
Breaking new boundaries
Thankfully, the spirit of innovation is still alive and well within the NHS. Practitioners employed by the service continue to make headlines pioneering new techniques and treatments that save lives and improve patient outcomes, with the use of digital technology featuring large.
One recent example was the world’s first use of 3D printing technology to support the transplant of a kidney from an adult to a child. Surgeons at Guy’s and St Thomas Hospital, London used the 3D printer to build models of the abdomens of the donor and patient, father and daughter Chris and Lucy Boucher, so they could accurately plan the highly complex procedure.
This kind of creative and inspirational thinking in how technology is applied in healthcare can inspire the answers to the funding and resource challenges the NHS faces. Technology has the power to drive huge efficiency gains through automation and data-led planning. In an organisation the size and complexity of the NHS, artificial intelligence (AI) has a huge role to play.
Through wireless communications, the internet and the cloud, digital technology also has the power to overcome barriers of location and distance, improving access to healthcare for patients and helping share resources more effectively.
Remote Patient Monitoring (RPM) systems, comprised of ‘smart’ devices worn on the body of patients, are already playing an important role reducing the burden on hospitals and GP services. Capturing health data remotely as people go about their daily lives cuts down admissions and appointments, while it actually improves early detection and diagnosis, saving on resources while improving outcomes.
At Proximie, we are proud to be playing our role. With surgical waiting times once again on the rise, the Proximie platform is part of the next generation of solutions being used in NHS hospitals to improve access to surgery for patients. With AR-assisted remote surgery, patients do not have to travel to where a registrar or consultant is based. Local surgical teams can deliver procedures under the guidance of the specialist via the Proximie app, freeing up beds and reducing waiting times.
Proximie is also playing its part in ensuring that innovation in technology and clinical excellence is nurtured and encouraged for years to come. Our co-founder, Nadine Haram-Hachach, is a fellow on the NHS Clinical Entrepreneur Programme. Launched in 2015, the programme offers a dedicated training path intended “to nurture the most inventive and innovative clinicians.” The intention is “to keep the most forward-thinking, entrepreneurial clinicians within this country, bringing the benefit of cutting-edge new treatments and care pathways to the patients who need it.” And, of course, keeping them within the NHS.
For 70 years now, this great institution has been built on the talent and innovation of its people. Here is to 70 years more.