How the UK health care system can spend its extra funding well

Britons will be breaking out the bunting this week as the UK’s National Health Service celebrates its 70th anniversary. Ministers have provided a birthday funding settlement of an additional £20bn a year for England by 2023. Now the hard work begins: how to spend the funds well.

The ‘spend’ bit is easy, the ‘well’ is not. Around the world, health systems are grappling with similar problems: how to get better care, for more people, from less money. Internationally, the NHS is of interest because reforms following investment have been faster paced and more numerous than elsewhere. What we can achieve may serve as a pointer to other health systems.

Yet the NHS’s record on progress resulting from large-scale reform and investment is mixed. So what do we need to do differently this time?

Given the NHS is almost entirely funded through central taxation, the reforms over the past 30 years have pivoted on questions of ownership, determining the proper balance between state control and incentives. Defining the problem in this way has produced big ‘bazooka’ reforms, such as a large and deeply unpopular structural shake-up 5 years ago. These changes intensified the challenges the service needed to address, encouraging competition when what was needed was far more collaboration between different parts of the system.

A real revolution to improve care must begin on the frontline of the NHS: with staff and patients. Change in any industry is hard. And the health service is by far the UK’s biggest, most complex, high-profile and inherently risky organisation.

The past 20 years have not been without merit. The numbers tell the story: 10,385 fewer people dying from heart attacks now than a decade ago; 8,390 fewer from strokes; 634 fewer from cancer. Productivity growth has averaged 1.4% a year during the past five years.

Now, however, the challenge and the opportunity are of a different order and need a more radical and imaginative approach. The demands on the NHS are intensifying and diversifying at speed. The number of older, frail people, with multiple chronic conditions, is rising. Significant technologies are on the horizon, such as artificial intelligence, and genomic and personalised medicine, that will revolutionise care. Some, such as apps and devices helping people to manage chronic illness themselves, may bypass NHS care completely. They must become part of the solution to preventing ill health, an area where the NHS – as well as other public agencies and, indeed, business – has been too passive.

Historically, reform has been transmitted from government, or NHS central command, through to institutions via their managers. This route will be too slow by itself to be effective. Quality of care, costs and productivity are determined at the front line. And the front line is now moving upstream as public agencies recognise the value of improving health and wellbeing rather than just treating the already sick.

But when it comes to supporting staff on the shop floor – where most of the NHS talent is – there is a long way to go. Last week I was with a group of 20 clinical and support staff in a London teaching hospital, learning to increase the speed at which patients move through the emergency department. Safety and efficiency were improved by identifying blockages, designing and testing solutions using data, and insights from staff and patients. ‘Why didn’t I learn this 20 years ago?’ said one consultant. In a rueful moment of insight, she added: ‘How could I do my job well without it?’

Reform must now be turned on its head. Improving workers’ skills to test innovation, boosting data analysis, and stronger management must be front of the investment queue. Staff and patients need support to design improvement. This more diffuse approach – faster evolution – is less showy than upheaval from the centre.

But it is also less risky, and is likely to be far more effective. For politicians, here’s the paradox: the best way to sustain the UK’s favourite institution to a healthy centenary may well be to let go.

Dr Jennifer Dixon (@JenniferTHF) is Chief Executive at the Health Foundation

This article first appeared on the FT