Opinion: Long term prognosis – what the NHS will look like at 80

Wonder what the next ten years hold for the NHS? Better ask the people who really drive change in the health service – the public, says Roy Lilley

Photo: PA

By Roy Lilley

06 Jul 2018

The bandwagon is groaning. No, not the Brexit bus. The NHS’ 70th birthday celebrations. Everyone’s publishing, writing, commentating, predicting, conferencing and, courtesy of The Royal Mint, there are even some souvenir coins. Expect an “NHS 70” tea towel any time soon.

The 70th anniversary of the nationalisation of the British health system is entirely artificial. It’s not a sentinel birthday, but it is a convenient distraction for a government facing hard times.

A convenient diversion even if there is no sight of the millions promised on the side of the Full-British-Brexit bus. The fact the NHS is 70 years old is interesting but unremarkable. After all, what’s the alternative for the UK? The NHS is reassuring, gives us all peace of mind and no government in its right mind will ever close it.

However, it is fun to think… what will the NHS be like at 80?


Ask the public, and they’ll tell you they’d like better access to their GP; that somebody should do something about the drunks in A&E; and an obesity tax isn’t a good idea as too many of us are heading in that direction and might have to pay it. Also, they don’t mind paying a bit more for the NHS, providing it isn’t pinched to fill holes in the roads or foreign aid.

All of which gives us a pretty good idea what the NHS will look like in the next 10 years.

The NHS is a slow adopter of innovation and change. It is cautious. Get it wrong in business and you can write it off, start again. Get it wrong in the NHS and you’ll have a disaster on your hands.

This means it is the public who are setting the pace of change. Getting an appointment with a GP is irritatingly difficult and impossible for commuters. The NHS shows no signs of sorting out GPs, who are a rule unto themselves. So, in the same way drivers will rat run to find a way around rush hour jams, the public is finding its own solution.

The astonishing success of online consultation service Babylon and other apps that allow us to consult a doctor on our mobile phone tells us what the future holds for primary care. Thousands have signed up already and the public enthusiasm for this type of access to care shows no signs of abating.

The self-employed GP contract is an arcane method of paying doctors, predicated, fundamentally on buildings. The public have decided the future is in clicks, not bricks, but we also need a new contract to pay doctors to look after frail, elderly people with long-term conditions. The future of the GP is in salaried employment.

The use of technology will also remodel the last remaining outpost of the unreformed NHS: out-patient appointments. Some say half could be done over the phone, Skype or FaceTime. With a bit of finessing, it could be two-thirds. The direction of travel is easy to see.

The public’s health has always been a challenge. It is the law that changes behaviour and MPs change the law – with one eye on their majority. Seatbelts in cars, smoking bans, health and safety legislation – all examples of laws that have worked. So what laws can parliament invent to make us thin? 

Perhaps, a planning restriction that chip-shops can only have 18-inch wide doors, allowing only skinny people to buy chips?  Laws on salt and sugar content in food, restrictions on alcohol, pre-package foods, advertising: we know what to do but governments across Europe are yet to find the courage.

Some much needed and subtle changes to the regulations to get the NHS administrative landscape back into pre Health and Social Care Act shape are on the horizon and will see the end of contracting and most of the clinical commissioning groups. No loss at all.

More difficult is funding, which is wholly dependent on economic performance. Post-Brexit, a slow down is inevitable. The prime minister’s NHS birthday bung of 3.4% (actually only 3%, taking into account the health department’s slice) is only enough to keep the lights on.

A hypothecated health tax is inevitable, sensible and has public support. It will be in at least one manifesto for the next election.

So, too, must be a commitment to get NHS funding back to around the EU average. Without that, it takes no haruspex to predict that in 10 years, the NHS could be a poor service for poor people.

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