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The NHS at 75 | blog from Dr Sarah Clarke

President Dr Sarah Clarke pens her reflections as the NHS marks its 75th birthday this week.

Like all birthdays, the NHS’ 75th is a time for reflection. 75 is a significant milestone, and it is one that I and I know many of my colleagues feel proud to be a part of.  

Medicine was not a predestined career choice for me – I chose to go into it after spending a year as a research assistant at the Royal Marsden before university. This is where I first saw the breadth of opportunities medicine offers throughout a career. Since then, I have had the privilege of holding many different roles that have allowed me to lead transformation in my specialty of cardiology. When I first joined the NHS, I would not have imagined that my career would lead me to being president of the RCP. I am pleased to continue to learn from colleagues and I am taking this milestone as an opportunity to reflect on how dynamic and wide ranging a career in medicine in the NHS can be, despite the challenges we currently face.  

Like many colleagues, the NHS has been my employer since I first graduated. There is no doubt that the NHS has changed considerably since I started my career, let alone over the past 75 years. Our health service now sees more patients, has evolving and state of the art diagnostic tools and can treat more diseases than could have been imagined in 1948. One aspect, however, has always been a constant: the people. The NHS workforce is central to the National Health Service. It is its best and most valuable asset.

The past few years have been incredibly challenging for our healthcare staff – responding to the COVID-19 pandemic, with the majority of RCP members providing direct clinical care to COVID patients outside of ITU, and now at the forefront of bringing down waiting lists which currently stand at over 7 million. More than four in five people on waiting lists need an outpatient appointment rather than surgical procedure. Our RCP 2022 census results published last month show how grave things are: 58% of consultant physicians report consultant vacancies in their departments and almost one in five say they are almost never in control of their workload.

The NHS is nothing without its people. That is why I said last week that the long term workforce plan (LTWP) is an important first step towards a sustainably resourced NHS. There is no doubt that it will be a long journey ahead to put the NHS workforce back on sustainable footing, and we’re analysing the detail of the plan closely, but it is welcome that we now have a roadmap for expanding the workforce. For years the RCP has called for more investment in the NHS, an expansion of medical school places and stronger workforce planning and through the #strengthinnumbers campaign.

A focus on retaining existing staff is key. Like many members, I have seen long standing colleagues leave the health service in recent years. While we hope that changes to pensions announced earlier this year will help to abate this, it remains the case that too many healthcare workers feel like they are burnt out. Almost a third said that they often think about leaving their organisation in the latest NHS Staff Survey and industrial action is on the horizon for both junior and consultant doctors. It is vital that staff feel supported and valued, including when it comes to their pay. The government addressing the current impasse will make a huge difference to patients and staff. Flexible working and training, time off for significant life events, working in a hospital with rest areas and readily available food and drink and getting rotas in good time are critical. It’s not just retaining those already in the service – we need to attract those who have recently left or retired back to practice.

Having a well-resourced workforce is central – but addressing avoidable illness and therefore avoidable demand is the other vital part of the puzzle. In December of last year, just under a third of our members told us that in the last three months they had seen more people with illness due to their living conditions. The RCP convenes the Inequalities in Health Alliance (IHA) - a coalition of over 240 member organisations campaigning for a cross-government strategy to reduce health inequalities. The NHS Assembly’s NHS@75 Report rightly identifies preventing ill health as one of three priorities for the future of the NHS. Tackling the wider determinants of health is key in preventing ill health in the first place, and government must show leadership to address this. Ultimately, the NHS can only go so far in preventing illnesses caused or exacerbated by the environments people live in.

I know that many colleagues share the view that the pandemic should have been a turning point, recognising the difficulties the health and care service faces. My hope for the next 75 years of the NHS is that with the implementation of the LTWP we can continue to deliver high quality care, free at the point of use, supported with the necessary workforce, funding and planning to meet the needs of both the public as patients and the staff that work in it.