NHS faces “existential threat” unless system adapts, warns ESNEFT chief
The chief executive says political tension, long waiting lists and industrial action all contributing to mounting pressure.
The future of the NHS is under serious threat unless urgent improvements are made to how services operate, according to a senior NHS leader in the East of England.
Nick Hulme, chief executive of East Suffolk and North Essex NHS Foundation Trust, says the health service is at a “vulnerable time”, with political tension, long waiting lists and industrial action all contributing to mounting pressure.
Problems the NHS is facing
Speaking about the direction of the NHS ahead of his retirement, Mr Hulme said the service is struggling to convince patients and the public that it is delivering value, despite unprecedented levels of investment.
“I think the NHS is a vulnerable time at the moment, and I don’t think the industrial action helps,” he said. “We are really struggling with getting waiting times down. Don’t get me wrong, there’s been massive improvement in the last 12 months, but people are still waiting significantly longer than they were five years ago.”
He said this was difficult to justify to patients, given the scale of funding, staffing and infrastructure investment in recent years.
“Despite all the investment that’s gone into the health service in terms of buildings, in terms of staff and in terms of money, we’re not helping ourselves at the moment in terms of the narrative that still says the NHS is fit for purpose and we’re improving people’s lives,” he said.
External pressures
Mr Hulme warned that the combination of public frustration and political division could place the founding principles of the NHS at risk.
“All of us need to recognise the vulnerability of health services at the moment, the vulnerability almost of the NHS as a concept,” he said. “There are political forces who don’t believe in the NHS as being free at the point of delivery and open to all.”
He said conversations about insurance-based healthcare models, similar to those used in other countries, were becoming more prevalent and that failure to address NHS challenges could strengthen arguments for fundamental change.
“Unless the NHS gets wise and it starts to address some of these major challenges that it faces, we’re just handing ammunition to those politicians that want to see the end of the NHS,” he said.
Public perception
Mr Hulme said public patience with the NHS is wearing thin, despite an understanding of staff pressures and the benefits the system provides.
“The public, I think, in the main are incredibly impatient with the NHS,” he said. “They do see how hard people are working to maintain good services, but equally they’re also aware of the huge investment that’s gone into the NHS for which we’re not seeing the productivity gains.”
He said patients are increasingly questioning why waiting times remain long, even after the opening of new facilities and the recruitment of additional staff.
“The people I speak to, whether it’s emails I receive, media interviews or people who stop me in the streets, say, ‘What are you doing with all that money? Why am I still waiting a year to have my hip replacement?’” he said. “It’s becoming increasingly difficult to answer that.”
Mr Hulme said this growing disconnect posed a serious long-term risk.
“I think there is an existential threat to the future of the NHS, and I’ve never said that before,” he said.
What will help?
However, he stopped short of supporting calls for sweeping structural reform, which have been advocated by some political figures.
“I don’t necessarily agree with the ‘reform or die’ message that we’re hearing,” he said. “There is an element of less reliance on hospitals, more investment in community, more investment in technology and prevention.”
He argued that, before abandoning current structures, more could be achieved by using existing resources more effectively.
“Before we reform, we need to look at what we’ve currently got and use it differently,” he said. “This is just about doing what we currently do better.”
Mr Hulme said recent investments, including tens of millions of pounds in new IT systems, should be fully utilised to improve efficiency, safety and productivity without the risks of large-scale reform.
“If we were just better at what we currently did, better clinical outcomes, more efficiency, more productivity, less waste, would we need the big, major reforms we talk about long term?” he said.
He acknowledged that the UK’s ageing population will inevitably require changes to how care is delivered in the future, particularly for older and frail patients, but said incremental improvement should be the immediate focus.
“For now, rather than big reforms, we just need to do what we currently do a little bit better,” he said.
Mr Hulme stressed that supporting the NHS’s core principle of care being free at the point of delivery was essential, warning that maintaining it comes with increasing pressure on hospitals, mental health services and primary care.
“We need to maintain that with everything that we possibly can,” he said. “But that comes with real pressure, particularly on our front door, and in our mental health and primary care services.”
Government response
A government spokesperson said:
"Under this government, the NHS will always remain a publicly funded service free at the point of use.
“But it does need fundamental change, and through modernisation and record investment, we’ve cut waiting lists by more than 200,000 and boosted productivity so patients get seen quicker and taxpayers get maximum value for money.
“There’s a long way to go, but the NHS on the road to recovery, and our 10 Year Health Plan will create an NHS fit for the future.”