The future of health

The central importance of the NHS to English national life can be expressed in numbers (with the service accounting for over 8 per cent of the whole economy and health accounting for a sixth of all government spending).

But even these figures cannot fully capture the costs to us all when opportunities for improving the health of the UK population are missed. Health is too important to remain outside the important debates on reform now taking place.

In recent days the adage that “a week is a long time in politics” has become fact – with the political ground moving beneath our feet. Debate is now centred on the need for a massive decentralisation of power, greater political and institutional accountability to citizens and consumers, and greater value for money.

So far the NHS has been excluded from this new and welcome debate. That can’t continue. The medium term funding outlook for the NHS, with baselines likely to be frozen in real terms for several years from 2011, means the UK health system has to be rethought now. To do this it is necessary to accept the need for greater rationing of resources and to be open to radical ideas and insights. Only through doing this would it be possible to ensure that necessary reforms are made prior to 2011 and the potential of the NHS is unlocked.

Some sort of beginning has been made with NHS reform – with initiatives such as choice and the world class commissioning programme – but the impetus of change has been placed at risk by the recession. However, it is precisely in such an environment that improving management and organisation in health care is important. The NHS has enough money – problems are due to underperformance not underfunding.

A debate on the high level of public expenditure on health and how to pay for a healthy future can no longer be avoided. Population ageing, a wider range of medical problems, and new technology mean costs are inevitably rising. Measures like top ups are expanding the funding base for healthcare, but it is necessary to go further with greater use of user charges and insurance-based private funding.

Health services are too important to remain outside the more for less agenda. There is wide variation in both the types and quality of services that trusts offer nationwide, and innovative high performers can provide important lessons on how to make better use of limited health resources. International experience, particularly in the area of integrated care, also has much to bring to the UK health debate.

Emphasis on knowing the patient will dramatically change the current NHS landscape. The information revolution will put patients in the driving seat of NHS reform. As informed consumers they will resist the one-size-fits-all culture of the NHS, and as such it will be forced to change to meet their needs. More care will be delivered locally and at home, and access will be transformed as patients choose where and how to receive their care, mirroring the consumer-led approach of the high street.