Now that the fun and games are over, what will the future bring? Let me clarify – I am not referring to the Olympic Games, for we have yet to experience the thrills and spills of the Paralympics. No, I mean the fun and games that was the passing of the Health and Social Care Act 2012. Now that the dust has settled on this gargantuan piece of legislation, what’s in store for the NHS in the months and years ahead?
In a bleak assessment of the outlook for NHS finances researched by the Institute for Fiscal Studies and published by the Nuffield Trust in July, we were told that we face a ‘decade of austerity’. The period 2011-2015 will be the tightest four year period for funding in the last 50 years and the authors warn of a far from rosy picture thereafter. If the NHS is to remain largely free at the point of use, available to all regardless of the ability to pay – as I so passionately believe it should – then on the basis of this report’s conclusions, dramatic increases in NHS productivity will be desperately needed.
But can we find them? I believe we have a fighting chance, but only if we focus on three areas…
Firstly, by encouraging, supporting and rewarding those clinicians and managers in the service with the ideas, the will and ability to execute change and improvement on the ground. Listening to the Health Foundation’s Shine award holders present their results at our June board meeting was inspirational. ‘Better quality at lower cost’ was their mantra. Even in those projects where real cash savings were not identified, there was plenty of evidence that more productive ways were being found to deliver services, thus improving productivity.
It was interesting however, just how many such initiatives were targeted at reducing the use of expensive secondary care services. Which brings me to my second point: now is the time to recognise that the longstanding pattern of general acute hospital services (established following Enoch Powell’s hospital plan for England in the 1960s) is time-expired.
All over the country small and medium sized district general hospitals are feeling the pinch. I call upon the newly established NHS Commissioning Board for England to make the development of a new strategic vision for acute care one of their top priorities. Just as Victorian asylums were closed and replaced with better and more cost effective community care, working to a well-developed and communicated strategic vision for mental health services, so we must now do the same for general acute care.
It is now almost exactly a decade since the previous independent report on the long-term funding of the NHS was published: Securing our future health: taking a long-term view, otherwise known as the Wanless Report. This made clear that unless the future pattern of healthcare delivery focuses on prevention and fully engages patients in decisions about their care, the gap between demand and available resources will not be bridgeable. This remains as true today as then.
So my third area for action is to make a reality of both supported self management and shared decision making. As my colleague Adrian Sieff says in the introduction to our most recent publication on this subject, here at the Foundation we will continue to inform the debate and to promote a shift in relationships so that the Wanless vision of a fully engaged patient, where patients are active partners in their care, becomes the norm rather than the exception.
Stephen is Chief Executive of the Health Foundation.