In November this year, NHS England reported the worst ever waiting times for cancer treatment. Over 69,000 patients in the UK have waited longer than the recommended 62-day wait from suspected cancer referral to the start of treatment. 13% of patients with cancer are waiting more than 104 days to be treated, double the maximum advised waiting time.
Both waiting and treatment plans for cancer have been deteriorating since 2013, and the rate of decline has inevitably been exacerbated by the Covid-19 pandemic. While it certainly created a shock in the UK’s publicly funded system, the NHS’s underlying issues are chronic. There are three major modalities of care – surgery, radiotherapy, and systemic therapy. Across this range, a four-week delay in treatment increases mortality rates by 6 – 13% with further increases if the delay is longer than a month. Communities with the largest cancer burden and still suffering the greatest repercussions of Covid-19 have the least access to timely care as the NHS struggles to provide capacity for an increasing level of demand. The delivery of urgent healthcare is failing in the UK, and at the same time health inequalities continue to widen, in spite of the government’s commitment to level up.
The NHS isn’t working. MP’s may continue to shout the loudest in terms of their support for UK Health Service, but the British public is falling out of love with it. More people are now dissatisfied with the NHS than are happy with it, across a broad range of incomes, sexes, and voters of different political parties. Support for it is the lowest it has been for half a century. Public sentiment is an important thermometer for healthcare, and the mercury level is rising. A report published by the OECD this year compared the NHS with 19 similarly well-off countries and it is hard to come to a positive conclusion.
The UK is 10th out of 19 comparable countries for spending on its health system as a percentage of GDP. Putting us mid-table.
In 2019 the UK ranked 17th out of 19 comparable countries for life expectancy.
For strokes and heart attacks the UK has the worst survival rates of comparable countries.
Across 5 different types of cancer measured by the OECD the NHS comes 16th out of 18 comparable countries.
For treatable diseases the UK is second to bottom – 15th out of 16. If we matched the average of other countries, we would save over 6,500 lives every year or 17 a day.
The only thing the UK tops the charts on is helping diabetics avoid limb amputation.
Despite the highly impressive efforts of NHS staff, our health system does not match the success rates of other nations. It would be easy to blame underfunding, but that is not the case; the OECD data shows that in comparison to other wealthy countries, our spending in 2019 at 10.2% of GDP exactly matched the spending of other countries. We’re bang in the middle of the table on that front. And while the NHS may provide free care, it’s important to remember that the care is rationed. The mores stress on the system, the greater the level of rationing/ waiting lists, and accordingly the troubling trends that were recorded in November.
The next obvious explanation is staff shortages. The last two years have shone a light on the truly heroic work done by hospital staff, so surely problems in hospitals would be solved by hiring more of them and paying them what they think they deserve? Again, it’s not that simple. Since 2009, the number of qualified GP’s has fallen by 8%, but the hospital doctors have grown by a third, outpacing the growth of the elderly UK population that accounts for an oversized portion of hospital demand. The UK allocates too much of its healthcare spending to hospital services, and less to preventative medicine, diagnostics, and residential care.
To reflect that the cure here is simply an infusion of cash and staff would be a misdiagnosis, therefore. Growing resources are being used to treat ever more sick people, but even fewer are being used to prevent them from getting sick in the first place. The whole system is set up for failure. Other countries have adopted an approach focused on prevention and are unsurprisingly doing better than us. Japan has helped 60% of lung cancer patients survive for 5+ years after diagnosis, whilst the UK manages to save only 21%. Italy’s hospital admission rates for respiratory diseases our one sixth of ours. So – what needs to change and what are the solutions?
In the 2022 Autumn Budget statement Jeremy Hunt committed an additional £6.6 billion in funding for the NHS over the next 2 years. He also promised a review to reduce bureaucracy and increase efficiency. The long-term investment should deliver significant changes in cancer care, but in order to save lives a more creative solution is also needed. Cash alone isn’t the solution. Whilst long-term investment will build capacity a shift in balance away from hospital care is needed. Put simply, in order to improve survival rates, the UK needs to deliver treatment within the recommended timeframes. We don’t need new research breakthroughs, but rather a more efficient and accessible pathway to diagnose and treat patients with cancer. The NHS have a critical lack of capacity, and these needs to be alleviated by organisations that can deliver the first stage of diagnostics and early care, freeing up their capacity to focus on specialist surgery, radiotherapy, and systemic treatment.
The past two years have dramatically shifted how consumers think about at home diagnostics, the importance of rapid testing, and the ability to take control of their own health through greater levels of visibility. Prior to covid, the only tests you could do at home were blood or pregnancy testing, but the pandemic forced us to realise that we can diagnose a range of infections at home. Younger consumers in particular are more engaged with their own health – interested in staying healthy and preventing future disease, and more disposed to at home testing to generate concrete evidence of their own health outcomes. Consumers are taking advantage of rapidly changing technologies to track, diagnose, and manage their health, and as a result at home testing has emerged as a key consumer health movement. Deloitte estimates that 30-40% of consumers are now using at-home diagnostics.
The role of both pharmacies and health/wellness focused retailers is, at the same time, evolving beyond the filling of prescriptions or sale of vitamins and supplements. Customers are starting to embrace selected retailers as hubs for a broad range of routine health and wellness services. This transformation is happening simultaneously with rising competition from online retailers such as Amazon, which is raising the stakes for local retail pharmacies. In the UK, companies like Holland & Barrett are rolling out a diagnostics model which can also change the model of delivery. This surge in healthcare consumerism, the decentralisation of healthcare, adoption of diagnostics, and the growing acceptance of retail as health hubs have set the stage for retailers to deliver the first stage of care and reduce the burgeoning load on the health service.
Testing alone is only one part of the solution, however. A diagnostic product on its own is not enough to meet consumer needs and address their health concerns. In order to maximise the value of self-testing , retailers will need to consider integrated services that provide a comprehensive service with diagnosis, advice, direction, and feedback.
The NHS faces two critical problems in terms of consumer behaviour at the moment which are leading to a failed delivery of care. Firstly, many patients requiring urgent care are not being diagnosed or treated quickly enough. Meanwhile, of the thousands that visit A&E with concerns, almost half of them are not at any risk. Convenient, accurate testing – driven by wellness empowered consumers – linked to digital platforms and powered by artificial intelligence, would allow doctors to prioritise those at greatest risk of a range of diseases, and allow others to stay at home or self-help, freeing up healthcare resources, saving more lives, and also more money. Healthcare focused retailers are expertly placed to deliver the adoption of a new, diagnostic approach to healthcare which not only empowers consumers to take control and prevent future problems, but also crucially frees up NHS capacity and silos it as a resource to correctly administer vital surgery, radiotherapy, and systemic therapy, delivered by a world class community of clinical workers, scientists, and researchers.
Like any chronic illness, the NHS’s burdens will not be cured with a sticking plaster. The road to recovery is to not only upgrade its physical capacity, but also shift the balance from treatment in hospitals to diagnostics and preventative at home medicine.
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