Abstract
Welcome to another year of hot debate on the state of the NHS. High demand, workforce shortages and financial pressures continue to besiege the world’s most celebrated experiment in universal health coverage. There is also the small matter that 2018 is the 70th anniversary of the NHS. Not that anniversaries should get in the way of important decisions, but at least this anniversary will serve to concentrate people’s minds on what the NHS means to staff and patients, the value it adds and how we might best sustain it.
The presumption here is that the public loves the NHS, despite the difficulties, and at the very least wants to preserve its essence. Meanwhile, the perception is often that politicians are happy to see the NHS dismantled and prefer other financial models that might be insurance-based or reliant on co-payments. It is hard to find clear policy on these matters but the current direction of travel does little to pacify those fearful for the future of the NHS as we know it.
Unfortunately, prospects of progress appear slim. The government’s main focus is Brexit, and the relations between ministers and NHS leaders are clearly strained. Staff remain demoralised with many eager to leave the NHS. 1 A stretched service nudges decision-makers in the direction of expediency instead of evidence-based policy making. In any case, translating research into policy and then practice is an insurmountable barrier for any health service. 2 Communication failures compromise patient safety 3 and are a greater challenge when demand outstrips workforce capacity.
Nonetheless, hope is not lost when you consider that advances in science continue to transform healthcare. Charles Swanton, from the Crick Institute, explains why cancer treatments do not work and in that understanding lies the key to unlocking therapeutic strategies that will save lives. 4 Imagine an NHS built on science and evidence, designed to put patients and carers first and investing in the health and education of its multidisciplinary staff. I know I’m a dreamer, but I’m not the only one. Tell us how you imagine a better future for the NHS and we’ll publish the best contributions in JRSM.