Sir William Beveridge, architect of the modern welfare state, wrote that there had to be “a national health service for prevention and comprehensive treatment available to all members of the community”.
At the time of its 70th anniversary, in July 2018, YouGov reported 87% of Brits were proud of the NHS, and in March, April and May 2020, the country united to stand at its doorways once a week to applaud health workers.
But Covid-19 has shown the future delivery of healthcare is likely to include a partnership between the NHS and private companies, enabled and catalysed by policies that are set to address the structural problems in the sector.
Nation & Society
We’ve seen increased interaction between the public and private sector to deal with peaks in demand, and what we learn could be a model for the future. Last August, for example, the government announced private hospitals would be paid up to £10bn to ease NHS waiting lists.
This may be expanded as a model. Traditionally, the focus of the NHS has been general. As healthcare makes more use of cutting-edge technology such as MRI, more of it may be based in private institutions. So, there will need to be closer association between the two, and our social contract may demand a partnership approach.
Another set of partnerships that may see some adjustment will be the inevitable partnerships between the NHS and big tech. This is mandated by the level of specialism tech companies bring to the cutting edge. We’ve already seen partnerships between five NHS trusts and Google Health to use artificial intelligence (AI) for applications like early cancer diagnosis.
But this means careful consideration over data sharing. Large anonymised datasets based on medical records can be used to create algorithms, but this assumes we share our data, perhaps using wearable technology, in return for advanced capabilities.
Work & Play
The crisis has focused our minds on the challenge of social care, both for the companies and workers who provide it and the unpaid carers who have to reconcile the needs of their families with work.
While flexible working arrangements may make it easier for carers to stay in the workforce, or re-enter it, this is not a solution to a problem that is driven by demographic changes. Pre-crisis, the projection [was] that the combination of Brexit and low pay in the industry meant that, without changes, the UK will be short of around 400,000 carers by 2028.
The shortage is partly due to the structure of the industry: almost three quarters of carers are paid below the real living wage, according to research by Skills for Care for the Living Wage Foundation, because of the economics of a sector that is adjacent to the NHS but separate from it. During the crisis these often-anonymous workers have become visible to us. Making care provision a desirable, better-funded job will be an important challenge.
Place & Community
It costs more than £2,000 a week for someone to stay in hospital. Long-stay wards in hospitals contain many unfortunate patients who have nowhere to go.
This could [potentially] improve if we build ‘care villages’. These are already a reality in the US and New Zealand. We have seen some amazing examples that have GP surgeries, dentists and primary care facilities on site. During the lockdown, they stopped vulnerable people from becoming too isolated, while ensuring they had access to essential services. I think that model could snowball over the next five to 10 years. It is effective, it suits the needs of the population and their families who don’t want to see relatives in homes and hospitals, and it is efficient.
Economy & Finance
For those who fear another bout of healthcare austerity, the encouraging news is that it appears big tax rises or spending cuts are not on the radar right now. But at some point, this will need to be addressed.