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Posted on: April 15th 2015

What are the Major Challenges to the NHS over the next Decade?

Our publicly funded health care system, the National Health Service, or NHS, is a much-cherished institution that is buckling under the strains of expenditure, funding, as well as constant re-structuring, reform and political interference. A highly complex organisation, the NHS currently struggles to cope with demand and whether it can reach certain targets, such as acceptable cancer survival rates, which currently are below the European average. Despite all of these pressures, the NHS is still free at the point of delivery and many of those who have experienced its care are full of praise for its staff and the care they received.
 
nhs-scheme2
 
Interesting facts associated with the NHS:
 
In 2014, it cost over £112 billion
The NHS employs over 1.7 million people in the UK and is the 5th largest employer in the world, after the US Department of Defence, Chinese army, Wal-Mart, and McDonald’s.
Over 3 million people are treated in the NHS in England every week
Given its complex nature and the fact that itslooks after the nation’s health the NHS faces some extraordinary challenges over the coming years. So what are these special challenges and why are they important?
 
In a nutshell, the key special challenges that the NHS faces over the coming years include:
 
Climate change
Antibiotic resistance
Technology and Big Data
Growing inequality within the UK
An ageing population
Climate Change
 
It may seem a little strange to include climate change within the challenges, but it is a key health care issue. Why? – climate change has caused and will continue to cause heatwaves, which can have a devastating impact on young children and the elderly. In August 2003 more than 20,000 died in Europe owing to a heatwave, with France being particularly badly hit, with nearly 15, 000 deaths. Climate change not only brings about heatstroke, but also changes the pollution levels, affecting respiratory health. Climate change is also influencing the migration of species such as mosquitoes and ticks, who may take advantage of a warmer UK to incubate and breed in the UK. Even a 2 or 4C change in temperature could see diseases such as malaria, dengue, West Nile virus, and Lyme disease. Models suggest these are possible vector-borne diseases that could be present as a real threat in the UK by 2030.
 
It is of course not just heat that kills, but also extreme cold and severe weather. Climate change has and will continue to produce extreme weather that disrupts lives and kills the vulnerable, especially prolonged spells of cold.
 
Antibiotic Resistance
 
In 2013, the Government’s chief medical officer for England, Professor Dame Sally Davies, described antimicrobial resistance as a “ticking time bomb” and she warned that routine operations could become deadly in just 20 years time, unless the problem was tackled. Today antibiotic resistance kills over 25,000 people in Europe annually. The use and misuse of antibiotics in medicine and farming has led to an increase in the numbers of bacteria that are resistant to antibiotics. Once the susceptible majority of bacteria are killed or inhibited by an antibiotic, owing to mutations, resistant strains emerge, which then repopulate and become the dominant form. Simply put, the evolution of antibiotic resistance is the result of natural selection. The NHS has been tackling MRSA in hospitals as well as multidrug resistant tuberculosis (MDR-TB).  What the NHS faces is a future in which routine operations and procedures could become life-threatening if drug companies cannot come up with new antibiotics or novel ways of tackling this rapidly emerging deadly biological arms race.
 
Technology
 
Technology is more likely to be friend than foe, although the rise of digital apps and wearable technology will create a huge number of challenges for the NHS.  With the advent of smart technology and the “internet of things”, data and monitoring are very likely to make medics’ jobs easier, but it creates Big Data and Big Data needs to analysed and have support systems.  Can a smart phone replace a doctor; will e-medicine transform how we treat patients? Will self-diagnosis through smart devices be a help or a hindrance given the complexity and independence of other physiological and biochemical variables? Will the NHS be able to support this change driven by technology? The NHS’s own history to date of IT systems has been a bit of a laughing stock so one is not quite sure what will happen in the future. Another potential issue relating to Big Data is who might get their hands on it? What happens when sequencing DNA becomes cost-effective and standards and your genome data is up for sale? Personalised medicine and synthetic biology will also increasingly become part of the solution to medical problems and these have a myriad of benefits and risks associated, plus also ethical questions.
 
Growing Inequality in the UK
 
Despite the number of people globally in poverty decreasing, within our shores, inequality in income is increasing between rich and poor. The UK is the only G7 country with wider inequality than at the turn of the century. Put simply, the rich are getting richer and the gap in incomes has grown between the rich, middle classes and the poorer in society. A shocking fact is those poorer in our society suffer the most diseases, such as cancers and cardiovascular disease. There is a North /South divide with the richer South generally being healthier than the North of England. For example, take liver cancer or disease – this is much higher in the North owing to heavy drinking (Blackpool is one of highest for liver cancer and disease for both men and women, while Bedfordshire in the South is one of the lowest). Inequality is linked to globalisation and the influx of many millionaires and now billionaires coming into the UK, buying up property and business investments. It is also linked to an emerging underclass who will become victims of technological unemployment, rising crime, poor housing and social conditions, all of which ultimately impact on health, especially for children.
 
An Ageing Population
 
The UK’s ageing population is well documented and by 2030 the over-65s will make up 23 % of the population. Not quite as bad as Japan or China, but the UKs demographic time bomb is going to significantly affect NHS services and put a strain on budgets as well the treatment of diseases of old age, typically chronic conditions such as dementia, Alzheimer’s and Parkinson’s , CHD or Cancers. The NHS is set up largely to treat single organ diseases, but older people often have multiple conditions to which the NHS would have to adapt. With people living longer owing to better medicine, diagnosis and healthier lifestyles, the NHS will be put under strain because unlike many other countries that have an extended family culture and nurse their elderly parents at home, many Europeans cannot cope with their elderly parents and place them in care homes or they often end up in hospitals. Problems are likely to occur in the form of bed shortages, strains on mental health departments and the numbers arriving at A&E departments. Technology and out-of-hospital care may offer much needed help, but in order to cope with the demand the NHS is going to have to significantly reform and restructure itself.
 
John Dalton
 
2015

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