Investment in the NHS facing up to the reform agenda


The need for new investment into the NHS is rooted in both financial and clinical realities.

Reform has previously shown that the acceleration of costs over this decade is placing the service under considerable financial strain. Without efforts to control costs and increase productivity, that strain will increase after April 2008 when the rate of growth of funding slows down. New investment can lead to greater efficiency by acting as a catalyst for service redesign to realise the potential for case management to reduce numbers of beds.

Developments in clinical practice require the same kind of new localĀ investment. To take one example from cancer care: new care standards such as a greater use of oral chemotherapy will allow more local access at community hospitals and primary care centres.

In recent statements, such as the White Papers Our health, our care, our say and Our health, our care, our community: investing in the future of community hospitals and services, the Government has supported this direction of travel. The latter paper argued:

“Services that are provided locally are more convenient and better able to meet our personal needs. They support independence and promote well-being by fitting closely with local circumstances and, when designed effectively, they offer real value for money.”

In a speech to the King’s Fund on 14 June 2006, Patricia Hewitt said:

“As we argued in the White Paper Our health, our care, our say, the balance of provision will shift, so that more often care is provided closer to home. Hospitals will, of course, remain important, but they will change. Some hospital services will be provided in local health centres and even in patients’ homes, as well as in modern community hospitals that can provide intermediate beds, day case surgery, diagnostics, out-patients and many other services. The old barriers between primary, community and secondary care – and between health and social care – will be challenged. New spaces for provision will be created, and innovative providers from any sector will find new opportunities to meet the needs of different groups of users.”

Governments have called for this new approach to service design before, notably in Barbara Castle’s paper on community hospitals thirty years ago.

But for the first time the current reform agenda – payment by results, practice-based-commissioning, patient choice and provider pluralism – provides the drivers to underpin actual change. It provides a very positive outlook for NHS physical infrastructure.

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