4 areas for investing in a healthy NHS

It's clear the NHS needs more funding. But what should the money be used for?

As the NHS turns 70, everyone is in agreement that it needs more money. The current pledged amount of £20 billion will help maintain current NHS standards in the face of an ageing population and the increasing costs of drugs and other treatments. But it will not be enough to modernise or improve our health service. And it does not address the need for additional funding for public health and social care – services crucial to maintain a healthy population.

We have previously argued that an additional £39 billion annually by 2023 would create an opportunity to fundamentally transform our health and social care system so that it allows everyone in England to live their healthiest lives. But what should that money be used for to ensure that our future health system is fit for purpose and does not need continual and costly restructuring?

There is not one easy solution. But here are four areas on which to focus to maximise returns.

1. Invest in wider public health and ill-health prevention

    An individual’s health is influenced by a complex interdependence of biological, psychological, social and environmental factors, so investing our collective funds to maximise collective health must also address these factors. 90% of our health is not determined by healthcare but other factors, such as our environment, job, relationships and the conditions in which we live. Yet less than 5% of total health spending is for public health. In England in 2013/​14, NHS spend was £1,742 per head compared to £49 per head for average public health spending, even though we know that investing in the prevention of ill health will save dividends in the long term. And there have been deep cuts in budgets since then with public health budgets slashed by 9%.

    In the short term, the NHS should work across government to invest in prevention. For example, a study of a charity providing mental health counselling in schools was found to improve long term outcomes for children including reducing rates of smoking, depression and school truancy. In the longer term, there should be an increase in public health budgets relative to the NHS budget.

    2. Invest in health and social care integration

      Social care helps people live in their own communities, improving wellbeing and reducing pressure on the NHS. Without social care, many patients can’t leave hospital. Yet cuts in social care funding and the complex divide between health and social care systems (partly arising as a result of difference in funding models) has led to many not receiving the care they need, languishing in hospitals or isolated in their own homes.

      Previous attempts to further integrate health and social care have not been particularly successful. However, investing in universal free personal care would align the systems more closely and allow further integration, whilst ensuring that everyone is able to access the care they need.

      This could follow the Scottish system, where anyone over 65 who needs support with personal care tasks in their home will receive it for free on a non-means-tested basis. Rather than the rigid, structured care package’ offered by many typical providers, people get to choose when and how their care is delivered, and what care they need and want. This means that carers do a whole range of tasks, from chopping wood to walking the dog to washing people’s hair. Personal budgets mean that care can be provided in whatever way will enable a person to live their life better.

      3. Invest in GPs and community care

        GPs sit at the interface between health and social care in communities and can play a vital role in working with patients, social care professionals and others to join up services and improve outcomes.

        GPs are already encouraged to personalise care, viewing a patient as a whole person rather than simply a list of symptoms. Some clinical commissioning groups and GPs are using a social prescribing approach, where primary care professionals can refer people to a range of local non-clinical services such as volunteering or sports in addition to standard clinical care. Such approaches should become the norm, and GPs should be trained both to have supportive conversations with those who come in, looking beyond the clinical and considering the social determinants of health as well as awareness of local services people can be signposted to. In order to ensure GPs have the time and capacity for such conversations, the health system needs to improve their recruitment and retention rates.

        Similarly, others in the community who have contact with many others, such as hairdressers, those who work in pubs, shopkeepers, librarians and so on should have similar training. In this way, communities will become more connected and people can access support as needed.

        4. Invest in the workforce

          The NHS employs 1.4 million people, and social care 1.6 million people. This amounts to nearly one tenth of the UK workforce. Therefore ensuring that working conditions are as supportive as possible will have a significant impact on our national health. All staff should be paid the living wage (including contractors), staff should have as much control and autonomy over their work, and as far as possible stress should be reduced in the workplace.

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