Across the world, a paradigm shift is needed towards keeping citizens healthy, rather than providing an excellent service for the sick: the UK’s NHS is the perfect illustration of the need for change.

Health systems across the world should broaden their focus away from merely treating patients when they get ill, towards a more holistic approach to health for all citizens. The results would be better outcomes and a reduction in system-wide costs. The UK’s NHS is an example of a system that must undergo a radical shift in its core purpose.

There are three things that healthcare systems across the world can do to improve outcomes for all:

  1. Social care must be prioritized around preventative interventions: this is cheaper than an illness service with a shift to combine under a one-aim, one-budget, one-organization approach
  2. Embrace a questioning culture and focus on citizens rather than patients: this should include close collaboration with other government departments and organizations
  3. Healthcare must learn from other industries: the NHS is an example of a system that must undergo a cultural change. Its sacrosanct place in the national consciousness needs to be challenged. All healthcare systems must learn from other systems that are driven by results.

The missing piece of the puzzle: social care

Social care, illness prevention and healthcare are intrinsically linked and must be managed together. If they aren’t, it incurs significant expense for a health system.

This essential integration has been omitted from Britain’s health strategy for more than 70 years. When Integrated Care Boards were established in the UK in 2022, social care should have been incorporated, but this is not being delivered in a meaningful way. The UK ministerial department is now titled Health and Social Care, but in fact, social care is treated completely differently and is disconnected from the health component.

The consequence is that it proves extremely costly when a UK user should be in social care but is stuck in a hospital bed. The business case to have more social care beds is clear and obvious, but local authorities do not have the funds to make it a reality.

Closely linked to social care provision is the subject of managing (and more importantly, preventing) lifestyle conditions, such as type-2 diabetes. The disease is highly preventable with a more holistic approach to health management. Currently, the NHS gets paid more the more people are diagnosed with it, when instead, it should be focusing on stopping people from developing it in the first place. To reduce the cost of expensive treatment, a different approach should be taken: incentivizing the NHS Integrated Care Boards to reduce the number of cases through prevention programmes. This approach would also be effective for other lifestyle health problems, such as smoking and alcohol abuse.

There is no reason why reablement too cannot be provisioned away from the hospital and in the home setting, with reviews and support designed to aid recovery and keep users away from the expensive medical setting. This approach is an effective, cost-efficient way to manage health and is better for the patient.

Focus on citizens, not patients

Currently, the NHS does not truly understand who its customers are and doesn’t understand its key outputs. There is a fundamental lack of proactivity; health issues are not anticipated and dealt with before they arise, which makes it far more costly when they need to be treated.

The management and structure of ICBs should be organised under one boss with one budget tasked to deliver healthy outcomes. Presently, the NHS doesn’t really deal with UK citizens until they enter a hospital or GP surgery.

The situation in the UK is getting worse, and health treatment is becoming less and less affordable. Local authority cuts are funding increased spending in the NHS. This means that the people who look to keep UK citizens healthy in social care are cut to fund the cohort of professionals who deal with illness.

NHS staff are working hard to do the right thing, but the system as it is currently configured is stopping them from doing so. The current approach is both inefficient and self-defeating.

Healthcare must learn from other industries

Health institutions like the NHS must start to look at other results-driven industries to understand how efficiency and effectiveness is achieved.

In the UK, the path to achieving this learning and development is hampered by the fact that the NHS is seen, as Nigel Lawson put it, as a kind of religion. The organization and its staff are wrongly seen as above criticism. The consequence is that the NHS’s central ethos and approach have gone unquestioned for decades.

This is in spite of the fact that in 2010, the OECD report covering the healthcare systems of the world’s richest countries commented that “The quantity and quality of [UK] health care services remain lower than the OECD average.”

The NHS must occupy a different place in the UK’s national consciousness. In simple terms, as things stand, the UK is paying a lot of money for an ‘OK’ health system, whereas other countries are spending a lot less, and achieving a much better overall result.

Shifting the paradigm in health

Why are health systems like the NHS allowed to continue making systemic mistakes, decade after decade?

The answer is that the remedy requires a long-term perspective and strategy which exceeds the bounds of the electoral cycle. It requires cross-party collaboration that is challenging to achieve and maintain.

Even so, some countries have succeeded in, or come closer to achieving, successful, health-focused systems. The insurance model, as seen in other European countries, allows for people and health organizations to be incentivized to stay healthy.

There is huge opposition to this model in the UK, often in the context of a comparison to the US. But that comparison is not necessary – instead the correct benchmark should be Germany and the Nordics, where healthcare is provided that is affordable for all users.

A simple example illustrates how effective this shift towards prevention, and away from cure, could be. The UK fire brigade a number of years ago took a strategic decision to focus their resources significantly on fire prevention, rather than just tackling fires. The result was a huge drop over time in the number of fires that the service had to attend.

The same shift in approach would pay a vital dividend in healthcare. But to do this, the NHS and systems like it need to put wellness professionals in charge, rather than illness professionals. This shift will in the long term lead to a reduced burden in terms of critical care and cost.

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