'The government of the day has ultimate responsibility for the NHS, and in a public system politics plays a legitimate part in the decision-making process. But the management framework - strategic coherence, a stronger scientific and education base and capable local management - is beyond politics and has to be pursued on a long timescale'
The purpose of the NHS is to secure through the resources available the greatest possible improvement to the physical and mental health of the nation by promoting healthy living, preventing ill-health, diagnosing and treating injury and disease, and caring for people with long-term illness and disability who require the services of the NHS. The very existence of the NHS is the mark of a civilised society - ensuring that health services are available to everyone on the basis of clinical need without regard for patients' ability to pay. This has been the ethos of the NHS for nearly 50 years. Managers and senior clinicians in the NHS are charged with the responsibility of sustaining these ideas at a time when people rightly expect high quality services which are organised and run for the needs of the individual rather than the convenience of the system or the institution. This is the enduring challenge of the NHS.
Medicine is advancing at a breathtaking pace allowing clinicians to do more, try more, extend life and even make diagnoses before birth. The determination of the genetic basis of common diseases, developments at the interface between biology and engineering, and the continued development of transplantation programmes are all things that we will have to face in the next five to 10 years, never mind the next 50. In the short term we must also tackle the difficult task of providing the full spectrum of health and social care for mentally ill people, the elderly and others with special needs.
Although technological advance is often cited as a burden on the cost of healthcare, it is important to remember that scientific progress can reduce costs and may even eliminate the need for treatment in some cases.
The development of antibiotics, vaccination programmes, minimally invasive surgery and the discovery that acid-related ulcers may be healed by eliminating a gastric bacterium are all good examples of this.
The rapid rise in the numbers of elderly people has been an important feature in the development of services in recent years. Although these numbers will continue to increase, the rate at which they grow will in fact be significantly slower over the next two decades than it has been since 1946. In addition, although life expectancy has increased, research has shown that these extra years of life are not necessarily years of severe disability but of mild to moderate health problems. Public expectations of the health service have grown hugely in recent years, as users legitimately want more say in the planning and delivery of services. We welcome this, recognising that a better informed and more influential public should also be more responsible in its use of the NHS.
The NHS continues to cope well with the increasing demands for high-quality services. It has grown to be the second-largest spending programme in the UK, which is a reflection of the funding priorities of successive governments. Over the past 20 years, NHS expenditure has risen by an average of 3% per annum in real terms. It is logical that the NHS should continue to share in a growing economy but these increases have to be carefully judged and there will continue to be a premium on good management in the NHS.
In a recent report by the Organisation for Economic Co-operation and Development (OECD), the NHS was recognised to be a 'remarkably cost-effective institution'. It achieves health outcomes comparable to those achieved in other countries with similar or higher incomes, and at a cost, in terms of share of national income, that is significantly lower than most. The NHS has retained the allegiance of the people to an extent that cannot be matched by other public health systems - only 12% of the population of this country has some form of private health insurance compared with one-third of the population in Australia, 40% in New Zealand and over 60% in Canada. Waiting times for treatment have reduced significantly in the past few years and labour productivity across the health service as a whole has risen by more than 40% over the past 20 years, broadly in line with trends in labour productivity across the British economy as a whole.
The NHS belongs to the people, and its top managers and clinicians, as temporary stewards of the service, have a responsibility to protect and develop it for the future. We are constantly striving to update and refresh our view of the future. The overall framework is straightforward.
First, we are pursuing policies which are about improving health and health services - Health of the Nation, community care and the Patient's Charter are all delivering results. Second, we are taking steps to strengthen the scientific and education base of health services, through the national research and development programme, the first of its kind in the world, and by our commitment to the continuous education and development of staff and a focus on clinical effectiveness.
Third, we are investing in the capability of local management - giving clearer focus to the quality and cost-effectiveness of services we provide and the well-being of the staff who provide them.
The government of the day has ultimate responsibility for the NHS, and in a public system politics plays a legitimate part in the decision-making process. But the management framework - strategic coherence, a stronger scientific and education base and capable local management - is beyond politics and has to be pursued on a long timescale.
When you are travelling around the world on business, have a look at other health service systems. The pressures are the same everywhere - no society has the ability to provide every treatment that patients would wish. Difficult choices have to be made about patient and service priorities and ultimately they have to carry public support. Throughout the world, no better model than the NHS has been found for adapting to change and development and for making the best use of available resources to meet demand for healthcare. Health service reform is a means to an end - better health and high-quality services for all are the goals for which we strive.