How to run a sustainable NHS

27 June 2014

The Coalition Government is implementing fiscal consolidation on an historic scale, and there is widespread agreement that consolidation will continue well into the next Parliament. The NHS is the biggest public services budget, and a vexed and challenging policy area. Reform held a private roundtable led by Rt Hon Stephen Dorrell MP to explore the challenges of running a high quality and sustainable health service as part of Reform’s major research programme on “How to run a country”.

Like all healthcare systems the NHS faces a daunting challenge to deliver high quality and affordable healthcare in the years ahead. Rising demand and the growing prevalence of long term conditions is placing mounting pressure on services in the face of constrained resource. Historically, demand has increased by 4 per cent per annum; a trend met through 3 per cent funding increase per annum and 1 per cent productivity increase. In the short term, fiscal consolidation in healthcare thus requires raising productivity to 4 per cent per annum to match rising demand. This means quadrupling the historical level of productivity in the healthcare sector. There was agreement that this unprecedented challenge will require nothing less than a transformation in the model of care.

In an age where 15 million people in England live with one or more long term condition, the majority of demand on the health and care system is for long term care and support, not medical interventions. Effectively managing the way services support patients throughout their lives, not simply within traditional acute settings, will be key to designing a health and care system that can cope with the challenges ahead. It was acknowledged that this will require a new shift towards prevention and supporting wellbeing for the population as a whole, not simply the patients who arrive at A&E. Yet the structures through which we fund and regulate care continue to create perverse incentives that focus attention on incidents of illness, not on supporting wellbeing outside of hospital walls.

The scale of reform required will rely not simply on health and care leaders to innovate and reform, but politicians at a national level to carry the public with them. The public is deeply invested in the 1948 model of care and the institutions and infrastructure that support it. The uncertainty surrounding what a future care model will look like in practice demands a vision and strong political leadership to build public consensus around the need for dramatic change to the health and care landscape.

Yet politicians have hitherto failed to have this open and honest conversation with the public about the reality of the challenges facing the NHS and the scale of change required. This may be explained by the notion that politicians do not pick fights which they expect to lose. Emotionally charged questions of the future of the local hospital or GP surgery are often sidestepped while politicians hide behind slogans about access and quality.
The result is that too often radical reform is postponed, but the scale of the challenge facing the health and care system means that delay is no longer an option. With another tough Spending Review expected soon after the election, the next Government will face greater pressure to effect reform at pace and scale. Yet structural reforms will have little lasting impact if they cannot carry the public and clinicians with them. Articulating a convincing vision of transformational change in the NHS will therefore be a defining challenge for politicians in the years ahead.

A blog by Camilla Hagelund, Senior Researcher at Reform, following a roundtable seminar on the theme “Delivering fiscal responsibiltiy: performance of Government in health” led by Rt Hon Stephen Dorrell MP, former Chairman of the Health Select Committee.





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