The basis on which our National Health Service should be operating for future generations has been set out once again. But how exactly do we turn the NHS Long Term Plan (LTP) into a reality? And does it go far enough to address the challenges facing England today?

Stephen Dorrell, Chair of Public Policy Projects, has published a new policy paperUniversal Healthcare in the 21st Century. The paper puts the question of delivering the LTP into a wider context and provokes a further discussion about what it means to have a universal healthcare system in the 21st Century.

The NHS represents the most cherished institution in the UK and the public support it enjoys is a source of strength. However, public support, “can become problematic when it transfers from the principle of universal healthcare and attaches instead to the institutions of the NHS,” says Stephen.

We now find ourselves in a situation where changes that could ensure the longevity of our health service are met with unnecessary waves of resistance.

Drastically changing demand and practice means that the institutions which make up the NHS, many of which remain largely unaltered since the 1940s, need to adapt and evolve. Central to this is the idea of an Integrated Care System – aligning the interests of the NHS, social care and local government in a way which addresses the social determinants of health.

The paper outlines a series of challenges that must be overcome in consideration of these reforms:

  • Value and affordability; value is created through improved life chances, not maximised activity. Healthcare systems must find a way of generating value while responding to the pressures presented by the inevitable growth of healthcare expenditure as a portion of GDP.
  • Innovation and digital technology; like every other sector of the economy, healthcare must harness the power if digital innovation to the extent where we are looking beyond “doing things better” to “doing better things.”
  • Social care and local government; we cannot address the social determinants of health without the full engagement of the community and wider public services. This cannot be achieved without the involvement of local government and, in turn, social care.
  • Pharmaceutical science; In an increasingly personalised age of medicine, it will become necessary to redefine the relationship between the provider of care and the producer of medical compounds. We must adapt to the incremental advancement of scientific progress in developing new compounds.

The UK’s status as an early pioneer of universal healthcare should continue to be celebrated. In doing so, we need to acknowledge the fact that “other societies have found other ways of delivering universal access to high-quality healthcare, at the same time as being more successful than the UK at allowing the health and care sector to grow in response to the wishes of their citizens.”

As Stephen asserts, the NHS has a major challenge to “ensure that while it celebrates its achievements, it is always in the vanguard of change and open to new ideas and good practice from wherever they come. ”

This is the “central challenge which faced the authors of the NHS LTP” and that we need to “resist the temptation to believe that other societies don’t share our objectives; should recognise the reality of shared aspirations and ensure we don’t miss opportunities to learn from them.”

As the paper succinctly concludes; “At the root, the issue is whether health policy is simply a form of transactional insurance, which provides protection against unpredictable risk, or whether it should be engaged and committed to improved health outcomes for all citizens. ”

Read the full policy paper here.