Future challenges for the NHS: looking ahead to the next five years

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What a difference an election can make. Before 6 May it seemed difficult to distinguish between the policies of the three main political parties on many health care issues. But one month on and it feels as if all the cards have been thrown in the air and no one is entirely sure how they will fall.

At a conference held on the future challenges for the NHS at The King's Fund earlier this week, delegates and speakers looked at the significance of the general election for the NHS, and explored the implications of the changing policy and political environment for those working in the NHS and other leading health care organisations. Since then Andrew Lansley has given his first significant speech as Secretary of State for Health, offering an insight into the new coalition government's ambitions.

The rhetoric in his speech was laudable and addressed some of the major weaknesses of the current system highlighted by speakers at the conference. A need to engage and empower both patients and professionals, a greater focus on outcomes, bridging the gap between health and social care, and addressing health inequalities were all touched upon. The context for the speech, held at the Bromley-by-Bow health centre, where GPs have worked in innovative ways with the local community to empower a traditionally under-served and deprived population, aimed to show what this would mean in reality.

What Andrew Lansley did not discuss, and indeed made a point of saying so, were 'structures, funding or processes'. Yet these are dominating the agenda for many frontline NHS staff. The current system of strategic health authorities and primary care trusts faces an uncertain future, and large numbers of managers face personal insecurity at a time when a tight grip and clear direction is needed. The collective financial challenge of £20 billion of unmet cost pressures in three years is seen by many to 'trump' all other issues. Finally, the current care pathways fail patients time after time, turning our acute hospitals into 'warehouses for frail, older people'.

Empowering patients and staff will be critical to addressing these challenges and Lansley is right to put these priorities centre stage. But empowerment will not be enough. Speakers at the conference said we need a workforce equipped with different skills and working differently if we are to deliver the integrated care that will stop hospitals from being warehouses and enable patients to be in control of their health. We need a workforce that uses the 12+ years of medical training to best effect, and uses clinical staff, such as pharmacists, nurses and physicians' assistants, to deliver the large quantity of routine care effectively. This will be critical in a cash-constrained world. However a great unanswered question remains: who in this new world will drive this workforce transformation?

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