Three challenges and a big uncertainty for the NHS in 2015

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The NHS faces three major challenges in 2015.

The first is to prepare for the spending review that will be initiated after the election. National bodies, led by NHS England, have set out their views on future spending requirements in the NHS five year forward view, and the major parties have all acknowledged the need for additional funding. While this is welcome, it is not yet clear whether any of the parties will commit to finding an additional £8 billion a year by 2020/21.

Ahead of the election, more work is needed to spell out how the NHS will find the £22 billion of productivity improvements expected of it under the five year forward view. We shall be playing our part by publishing an analysis of how the NHS can deliver better outcomes at lower cost. We shall also be working with colleagues at the Health Foundation to explore how a transformation fund might be used to support the development of new care models. Both projects will report in the first half of 2015 with a view to influencing the incoming government.

The second challenge is to achieve much closer integration of health and social care, both within the limits of the current system, and through a new settlement – as outlined in the Commission on the Future of Health and Social Care in England’s final report, published last year. As the Commission argued, there is a compelling case to bring the funding of health and social care together through a single ring-fenced budget, enabling entitlements to social care and health care to be more closely aligned and reducing the unfairness and complexity of the current system.

Implementing a new settlement would be a fundamental change and may well take a decade to deliver. Hard choices would have to be made to find the required resources, and the Commission was clear that older people, as the principal beneficiaries, would need to contribute some of the cost. The prize to be won is equal support for equal need and an end to the current fragmented system, which is often distressing for the people who most need help and support.

The third challenge is to ensure that the NHS has the leadership in place to deliver the highest possible standards of care within available resources. Our recent survey with the Health Service Journal found worryingly high levels of vacancies among executives on NHS boards. There are many reasons for this, including a punitive regulatory regime that is currently inclined to replace leaders who get into difficulty rather than support them.

The NHS needs to move beyond heroic and pace-setting leadership to an approach that is collective and distributed and engages staff at all levels in improving care. High priority should also be given to developing collective leadership in local systems of care to sustain existing services and implement new care models. We shall be publishing the results of our research on what it means to be a system leader at our annual leadership summit in May.

In tackling these challenges, the NHS also has to deal with the uncertainty around the general election in May when there is every prospect that no party will emerge with an overall majority. The rise to prominence of smaller and so-called insurgent parties means that another coalition is likely, quite possibly involving three parties rather than two.

This would have implications for the NHS. As Nick Timmins showed in his seminal study of the Health and Social Care Act 2012, negotiations inside the coalition had a significant influence on the White Paper, Liberating the NHS, and the subsequent legislation. This included the decision to abolish strategic health authorities and primary care trusts even though the coalition’s programme of government included a commitment ‘to stop the top-down reorganisations of the NHS that have got in the way of patient care’.

In the light of this experience, NHS leaders would be well advised to plan for the election by setting out clearly their priorities for the incoming government. These priorities should include changes to be avoided – like top-down reorganisations – as well as positive proposals for action. The NHS has done well to absorb the impact of major restructuring but desperately needs a period of stability to be able to focus on its core business of improving patient care.

Comments

Sarah

Position
senior nurse,
Organisation
district general hospital
Comment date
12 January 2015
Thank you, Chris, for your blog. I have >25yrs experience working within the NHS in District General Hospitals and, latterly, also experience as a user of services by proxy, given both my mother and father's health problems. It seems to me that the strength of the NHS lies in its emergency medicine provision. The weakness of the NHS lies in its management of chronic disease. Given the exponential rise in demand of the latter, surely the key challenge for the NHS lies in its ability to survive at all. Let's be clear, the system is in crisis as never before. Repeated top down structural change has not resulted in cost saving - it has only forced cost up, whilst also wearing down those that have had to implement these changes. Experienced clinical staff have left in droves in recent years, leaving a huge vacuum. Perverse incentives inherent in the purchaser/provider system and the focus on targets perpetuate waste and, often, poor care. Mid staffs weren't an exception. They were just the ones that got caught and provided a welcome target for politicians and the media. I had a great belief in the NHS when I started out all those years ago. I believed it was the best health care service in the developed world. I now think it's one of the worst. Surely it's time for an open and honest discussion about its future.

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