The NHS: a neglected geriatric patient?
Edmund Stubbs, 16 April 2015
Today, Sir David Nicholson, former head of the NHS’s, statement that the Service is facing a ‘substantial financial problem’ has highlighted the inadequacy of the healthcare pronouncements in the various parties’ election manifestos. All have offered additional billions of healthcare funding, but, in the light of Sir David’s words, this seems the equivalent of putting more and more buckets under a leaking roof.
The Conservatives and Liberal Democrats and Green Party have acknowledged the £30 billion annual funding gap predicted to exist by 2020 and have promised to add £8 billion (the Greens £12 billion) to the the £22 billion efficiency savings the NHS is expected to make over that period. However, there are many who think that anything like £22 billion of efficiency savings will be extremely hard to achieve; especially, given the NHS’s previous dismal performance. Between 1995 and 2010 the NHS made average efficiency gains of 0.4 per cent per year rising to 0.8 per cent (due to increased urgency) after the financial crisis. The NHS is presently pulling out all the stops to be as effective as possible, but, even if current efficiency gains were doubled, the NHS would still be left with an annual funding gap of £16 billion.
Annual cumulative efficiency gains of 3 per cent have been estimated as being necessary to close the funding gap altogether. However, Sir David Nicholson has stated that, with regard to even £22 billion of savings, that even though such a level of savings might be possible, ‘there is no healthcare system in the world that has delivered this scale’. Even increasing efficiency gains from 0.8 to the 1.5 per cent necessary to bring the funding gap down to £16 billion seems unlikely. There surely comes a point where ever bigger efficiency savings might begin to erode the core structure of the NHS itself, threatening care quality and patient safety. The NHS is possibly already close to this point. Additional radical action is needed
So, what can be done ? Firstly we must acknowledge that the NHS was established to treat the common diseases of 65 years ago and has become a victim of its own success. We now live longer and survive formerly fatal illnesses, but are consequently often left with long term chronic conditions that cost large amounts to treat. The proportion of elderly in our country has greatly increased. Thus we have more, often unwell people, dependent on every working age person in society.
With this in mind it is highly likely that post-election there will have to be a large scale public debate about the NHS and its future. Most agree that the NHS’s core principles should remain; that the service ‘meets the needs of everyone’, ‘is free at the point of delivery’ and ‘is based on clinical need, rather than ability to pay’. However, we must not view the NHS’s past organisation as ‘sacred’. That was then and this is now.
Restructuring the NHS does not necessarily mean bringing in private providers or abolishing the NHS logo. What it might mean, however, is that more care be gradually moved into the community. Hospitals might merge to become fewer ‘centres of excellence and specialisation’ instead of many ‘jack-of-all-trade’ type local hospitals. Management too might become more localised with the merging of health and social care budgets. In short, we must expect and welcome change. Even though we must remain cautious, we must implement change rationally, even when it may not be like ‘what happened in the good old days’, and especially when such change produces better outcomes.
Healthcare must become ever less about flashing blue lights and big hospitals, it must become increasingly focused on overall population health, and the promotion of healthy living, thereby reduce the demand for services. We must become better at identifying those at risk of future illness, and, as is the case with the healthcare devolution plans in Greater Manchester, take effective early preventive action.
Many have warned of the dangers of yet another, system wide reorganisation where front line staff have been described as ‘dancing on a moving carpet whilst trying to care for patients’; however, Sir David Nicholson’s intervention reveals that gradual but fundamental change must come if our NHS is to survive.
Edmund Stubbs, Healthcare Researcher, @edmundstubbs1