2014/15 looks like being a watershed year in which the NHS moves decisively into deficit. Although the political parties have begun to debate the level of funding that will be needed, it is not clear by how much the NHS budget will increase. The impact of continuing financial constraints on patient care is also uncertain.
What is obvious is that the NHS is currently run on the basis that money follows targets. The government’s very public commitments on access have resulted in money being channelled to these areas – for example, the additional funding provided in 2014/15 to help hard-pressed providers deal with lengthening waiting times for elective care and treatment in A&E.
Services lacking high-profile targets – like mental health and primary care – have not benefited in the same way, and there is growing evidence that patient care is suffering.
It follows that new areas of political priority, such as safe staffing levels and seven-day working, may also attract additional funding to enable aspirations to be turned into practice. The difficulty this presents is that with around two-thirds of hospitals’ budgets going on staff, the costs of these commitments is likely to be considerable. If the next government does not provide sufficient additional funding, it may not be possible to deliver on them.
Future funding levels will also determine whether NHS providers will be able to maintain current staffing levels, which in many cases have grown as a result of the Francis effect. Providers will be understandably reluctant to put safety at risk but, faced with the challenge of balancing budgets when workloads and deficits are both growing, they may not feel they have a choice. Much will depend on how regulators weigh these risks in their dealings with providers.
Much will also depend on the ability of NHS providers to extract further improvements in productivity to bridge the £30 billion funding gap identified by NHS England. The Fund’s analysis shows that the Nicholson challenge has been delivered mainly though controls over pay and prices and cuts in management costs.
Looking ahead, the main opportunities lie in reducing variations in clinical practice by tackling inappropriate use of services and inefficiencies in the delivery of care. There are also opportunities to reduce harm to patients and the waste involved in not providing care right the first time.
It will be much harder to realise these opportunities than it was to deliver the Nicholson challenge because it requires staff throughout the NHS to be engaged in improving productivity rather than relying on national leaders to exercise crude controls over pay and prices. And as our work on high-performing organisations has shown, engaging staff in quality improvement takes time, and often exceptional leadership, to deliver results.
Given the state of the public finances, it is unlikely that the next government will find all the resources needed to fill the funding gap. We are therefore starting a new project to illustrate the scale of the opportunities available to the NHS and to highlight examples of improvements in care that have delivered better value.
The project, reporting in early 2015, will illustrate how extra investment needs to be linked to continuing innovation in how clinical services are delivered if the NHS is to deliver financial balance and maintain acceptable standards of patient care. We would welcome contributions and suggestions on ways of delivering better value in the NHS as well as ideas on how the current barriers to innovation might be removed.
- See our priorities for the next government
- Read our reports: Reforming the NHS from within and The NHS productivity challenge
Comments
You could ask why haven't this still not been grasped by those that manage and decide on policy? There are some real gems but could it be that overall, despite promises and cut backs, 'pips are still not really squeaking' in this area and until they do, there will be no real management change as most continue to feel safe in the knowledge that the service remains the Governments electioneering friend and new money still keeps coming in. Why therefore put your name on the line when you can get away with the 'heads down approach'?
Heroic leadership not required but a massive resiliance is a key competency for all NHS managers. See Nuffield reports on impact on staff.
The proliferation of paper work that I have seen in the NHS and all Care Systems in response to fears of Litigation damages Patient Care and must cost multi millions in Professional Medical Time. My formal complaints on the subject have had the response that 5 year plans to computerise everything will solve the problem.
The NHS record on computers is poor. Many sharp end staff lack computer skills and that currently slows jobs down in many areas.
The RAF deployed their first sharp end Computer in 1964, designed by experts and not fit for purpose. We replaced it in 1971 AFTER a Working Party that included ALL ranks and duties specified exactly what the job needed in detail and ensured that the programmes delivered were fit for purpose. That approach WORKS.
The cost of what happening now is massive in financial and Patient Care terms. How much litigation money has been saved?
The whole needs costing and review. NHS I love you but please learn from the experience of others on many fronts.
Senior clinicans have no where to go except senior management or some kind of project/transformation role - which takes them away from clinical care.
As a result, our services are being run on the front line by the most junior staff while whole gangs of directors run around wondering about why we can't improve quality and safety.
I think it's probably quite obvious!
Add your comment