The NHS if: challenging questions for the future

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The severity of the challenges facing the NHS can often lead to short-term thinking. The King's Fund is launching a new series of essays that takes a step back from the 'here and now' to explore a range of hypothetical scenarios for the future of the NHS.

What if antibiotics were to stop working? What if every patient in the NHS were to have their genome mapped? What if people were to own their health data?

These questions are very different from the kind of things that are normally asked about the NHS in politics and the media. We're more used to hearing things like: by how much are NHS providers in deficit? What proportion of patients wait for more than four hours in A&E? And how much extra money has the government really invested in the NHS this year?

The second set of questions is important, of course. Their answers tell us something about the scale of the problems facing the NHS today. Hospitals are in deficit by at least £2.5 billion and probably more. In the last quarter of 2015/16, 12.1 per cent of patients waited more than four hours in A&E – the highest for more than a decade. And the NHS budget has grown by only £1.8 billion this year – every pound of which is likely to be wiped out by NHS-specific inflation.

The challenge, however, is that dealing with today's problems can often crowd out time for thinking about the future. This is completely understandable when these problems involve people's lives and large sums of taxpayers' money – things that can hardly be ignored. But the danger is that planning for tomorrow gets forgotten and short termism prevails instead.

Examples of this aren't hard to find. Cuts to public health budgets, for instance, may save money today, but create big problems for people's health and the NHS in future. Shifting capital spending (for things like new buildings and equipment) to revenue (in other words, income) – a common accounting trick when budgets are tight – may help fill growing NHS deficits, but stores up problems to be dealt with further down the line. The list goes on.

This is one of the reasons why, today, The King’s Fund is launching a new series of essays called 'The NHS if' which looks beyond the 'here and now' to think about a range of hypothetical scenarios and their potential impact on the future of the NHS.

This is where the first set of questions come in. We'll be publishing essays responding to these and other 'what if' questions about the future of health and care throughout the rest of the year. Experts from inside and outside the Fund have been asked to offer their personal responses to the hypothetical questions posed by us. (The essays therefore represent the views of the authors and not necessarily the views of the Fund.)

The questions broadly cover three areas: the NHS and society; medicine, data and technology; and how the NHS works. Some of the questions are more realistic than others – some aren’t realistic at all – but all aim to stimulate new thinking and debate about the future of health and care in England.

Today we publish the first four essays in the series. Chris Naylor writes about what it would mean for the NHS to go carbon neutral. Nick Timmins guesses what Beveridge would say if he were to report today rather than in 1942. Ilora Finlay considers what would happen if 'assisted dying' were legalised (and argues strongly that it shouldn't be). And David Oliver describes what the NHS might look like if community services for older people were available 24/7. We invite you to let us know what you think by adding your comments below the essays or tweeting using #nhsif.

Dealing with the current crisis facing the NHS is essential. But so too is planning for the future. 'The NHS if' is our attempt to provide space for thinking differently about what this future might look like – either for the better or worse – and what it means for the NHS today.



Comment date
04 July 2016
We wonder why the public sector does not generate its own incomes without putting the burden on uk tax paying patients.

For example why doesn't the vast hospital grounds have a wind turbine or solar panels. The area of cover could feed electricity back into the grid generating income.

Commercial masts for telecommunications could rent space. Also the surgeries are funded by the nhs so other doctors and nurses can man it when the daytime medics finish to relieve a and e's Most people hot desk now 24/7 and there is no reason why the public sector doesn't modernise itself in this way. The nhs pay the surgeries for the rent so it is not exclusive to the daytime doctors

kevin riley

Retired Public Sector Solicitor and User and active Supporter of Doctors and Nurses working in the NHS,
Comment date
07 July 2016
Unless and until there are sufficient nurses and doctors employed by the very highly paid Chief Executives running NHS Foundation Trusts to provider adequate front line care all this type of academic discussion will have no effect on "patient outcomes" whatsoever.

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