Playing the long game

The tension between demand and capacity is not new in the NHS. Over the past decade, the complex healthcare needs of an ageing population have compounded capacity challenges, leading to a steady trend of declining outcomes and increasing inequalities. The pandemic has rapidly accelerated this, but it was happening before.

This isn’t unique to the UK. When I speak with colleagues in my own organisation, working in other countries, these issues – together with the scale and pace of scientific advances – challenge healthcare systems globally.

Many stakeholders are offering views on the plans laid out by the new Heath Secretary to tackle this trend in the UK. I was struck by the perspectives shared by the International Longevity Centre (ILC), which warns that in addition to her intended focus of ‘A,B,C,D – Ambulances, Backlogs, Care and Doctors and Dentists’, we shouldn’t lose sight of the P: prevention.

I agree with the ILC – keeping people healthy is key to NHS sustainability. It will provide space to find long-term solutions to the big issues: workforce, backlog, and acute care, and help government achieve its 2035 target of five extra healthy years.

But, if we don’t consider prevention as more than keeping healthy people well, we risk limiting the positive impact we have on the system.

There are 15 million people in England living with a long-term condition (LTC).¹ For them, delays in accessing care or appropriate treatment can mean disease progression, more years lived with disability and reduced quality of life.

Preventing this spiral into poor outcomes, complex care needs and economic inactivity must be part of the recovery plan. It makes sense for patients; the system; its workforce and the economy. The Institute for Public Policy Research (IPPR) recently estimated there are approximately one million additional people missing from the UK workforce than pre-pandemic levels and a third is due to poor health.² In migraine alone there are approximately 43 million lost workdays per year in the UK.³

How can we do better for people with LTCs? Rethinking where; how; by whom their care is delivered; and ensuring earlier access to cost-effective medicines are all enablers of improved health outcomes and system resilience. Progress has been made on some of these but not enough.

Despite advances in treatment, almost one third of people with rheumatoid arthritis give up work within five years of diagnosis.⁴

Accelerating progress in these areas will achieve greater impact. This doesn’t need wholescale system change, but it does need all stakeholders to lean into collaboration. Healthcare cannot just be the job of the NHS – the country can’t afford it to be.

^{1 NHS England. House of Care – a framework for long term condition care. Available at: https://www.england.nhs.uk/our… . Last accessed 27.09.22}

^{2 The Institute for Public Policy Research (IPPR). Health and Prosperity. Available at: https://www.ippr.org/files/202… Last accessed 05.10.22}

^{3 The Migraine Trust. State of the Migraine Nation. Dismissed for too long: Recommendations to improve migraine care in the UK. Available at: https://migrainetrust.org/wp-content/uploads/2021/09/Dismissed-for-too-long_Recommendations-to-improve-migraine-care-in-the-UK.pdf. Last accessed 05.10.22}

^{4 Young A, Dixey J, Kulinskaya E et al. Which patients stop working because of rheumatoid arthritis? Results of five years’ follow up in 732 patients from the Early RA Study (ERAS). Ann Rheum Dis 2002;61:335–340 https://ard.bmj.com/content/61/4/335.}

October 2022

UK-ABBV-220546