What will the NHS look like in 2088?

What will our NHS look like in 2088? As Future Generations Commissioner for Wales it is my job to be the advocate of the interests of future generations, to pull up a seat, so to speak, at the decision-making table for our younger generations and even those not yet born.  And this is important because there’s a saying ‘if you’re not around the table then you’re on the menu’ and I think we can all see where our decisions and the debts of the past are now the burden of future generations.

It’s my job to question what type of health service we will be handing to our future generations? Will it exist at all in its current form? Of course, when we think of the future and think about technology, the exciting developments, the disruptive developments, robots are already performing surgery, Artificial Intelligence is diagnosing and monitoring, and our smart watches and fit bits are telling us to get more active.

But futures forecasting based only on technology is future forecasting which is missing the most important things in life, the things that endure from one generation to the next, the very things which make us human. Those trends are already evident, there is an increase in loneliness and isolation, poverty, poor mental health, obesity levels and adverse childhood experiences.  All those things will require a medical intervention, most likely a costly one, if we carry on doing things the same way we do now and these things will mean that the health service has very little chance of coping in the future.

And in looking to the future there are always lessons we can learn from the past. The warnings around our failure to recognise and act on the social determinants of health, the health impacts of mass unemployment, and here in Wales the health impacts of the wrong type of employment, the links between the quality of our environment and our relationships and the health of our nation.

But we can also learn from the good things where care was a community business, where our healthcare system was as focused on relationship building, compassion and community as it was on process, risk management and budgets.  In many ways we have not yet learnt the lessons from the past but it is essential that we do, if we are to create the right system or indeed be able to pass any viable system on to our future generations.

An approach fit for the future is, in my view, one where our public services invest in what makes our whole lives better, rather than what works for them, where the connection between the social, economic, environmental and cultural well-being is understood clearly.

The last few weeks have seen the Government’s responses to the parliamentary review of health and social care ‘A Healthier Wales; a Plan for Health and Social Care’, the launch of the Bevan Commission’s Charter for People’s Health.  They all talk sense but what we really need in Wales is delivery.  And that will mean some tough decisions.

It will mean, in my view, dedicating any new resources for health, not just to the NHS,  but to spend in agreement and in partnership with others such as our public bodies, like local government, the police, the fire and rescue service, Natural Resources Wales and also with people and the third sector.

If we are to shift from the trajectory towards meeting unmanageable demand it will also mean that this money should only be spent on prevention. There has already been an announcement of a £100m Transformation Fund but the bigger prize is probably around how the Government will decide to spend the consequential from the UK Government’s announcement on increased NHS spending.

The big question for the Welsh Government now is whether they will put their (new) money where their mouth is, in terms of actually funding the shift towards supporting well-being, rather than treating ill health.

And sometimes less is more. Whilst I don’t doubt the pressures on the acute end of the health system, is there really any incentive to change when we keep plugging the funds gap for more of the same, requiring them to plan and report on more of the same?

The Royal Pharmaceutical Society states that 50% of prescribed medication is either not taken or not taken correctly and on top of this, ‘poly pharmacy’, ie prescribing of a multiplicity of drugs, can actually be quite dangerous resulting in multiple hospital admissions through contra-indications, or, for example, through falls in the elderly.

What should the new responses to this be?  I’d start with different disciplines within health, working together in a primary care setting, but the bigger deal is about how we then expand that to non-medical models, models which focus on building relationships, tackling poverty, poor housing, physical activity, the importance of place making and community cohesion, and access to green spaces.

There are some brilliant examples of where this is starting to happen, for example a programme of intergenerational work in Gwent where young people are working with older generations, particularly those who are lonely or in care homes, pimping zimmer frames, singing, dancing, writing letters, drinking tea – all the softer things in life which cost very little but which mean a lot both for the individuals and for saving resources in the long-term.

A healthier Wales is not just the sole responsibility of our health boards. But neither is it their only goal. It is the responsibility for each and everyone of us to ensure we are working, day in and day out, to all seven of the well-being goals within the  Well-being of Future Generations Act.

If the NHS is going to survive we must become more resourceful as a nation in how we make the connections between all the things that keep us well, then I think our future generations would have a better chance of being able to access a new and reformed NHS which doesn’t require critical care itself but instead is healthy and well.