It’s not the money, stupid… it’s what we promise to do with it that matters….
There have been many column inches written about whether the NHS has received adequate funding to meet the demand it is expected to face in the years ahead. Much of the media scrutiny surrounding the Prime Minister’s decision to increase NHS funding earlier this year has centred around whether it is enough to manage existing demand and transform services for the future.
The NHS has been given a rare opportunity to develop a Long Term Plan – one that has the potential to span two governments over the next ten years. The crucial question is how to use this money to ensure a health service fit for the future. This is particularly pertinent given the rising patient demand and growing financial pressures facing the NHS.
So here are some priorities for the Long Term Plan if NHS England, NHS Improvement and the other national leaders want to square the circle of demand and supply whilst tackling the issues that matter most to patients, delivering an integrated health and social care system, and remaining politically credible:
- Don’t promise to make up all the ground on all the access targets. Instead focus on the very important targets where speed is of the essence for immediate clinical outcomes, such as cancer waits and blue light ambulance journeys. On issues such as A&E waiting times, focus more effort and scrutiny on patient experience. This is far the more important measurement as, in reality, few patients can differentiate between those departments that are meeting the standard of 95% of patients admitted, transferred or discharged within four hours; and those departments that are only achieving 85%.
- Look at using some different metrics of performance and choose those that better reflect the aim of delivering improved population health management. So, for example, by choosing a measure such as ‘the proportion of over 75s living independently’, you will help speed up the delivery of integrated care and increase the likelihood of funding solutions such as community support. You might even look nationally to adopt some of the thinking in Greater Manchester, where success is beginning to be defined as ‘school readiness’ or measures of ‘hopefulness in the teenage population’, for example.
- Allow longer periods of time for improvements in service performance to materialise, bearing in mind that the transformation of organisations takes time, and indeed recognise that it also takes cash to oil the wheels of change in the short term. Rather than promising straight-line performance improvements, commit to sustainable improvements when new systems and new ways of working are in place across the board.
- Re-calibrate the allocation of resources to address the physical, psychological and social needs of the population; the current position under-addresses the last two and, as a consequence, drives more of the first.
- Be realistic about the need to have an adequate level of management staff within the NHS. Without an appropriate level of spend on management, the system will be worse-off. It is imperative to avoid reducing management spend further as it is fundamentally counterproductive and does not benefit the clinical staff.
- Work more constructively with pharmaceutical and medtech companies by focusing on value creation and not just price reduction. In a post-Brexit environment, these industries need to see the NHS as a place that they want to do business. If the NHS can get this right, then it can genuinely start to discuss risk share and value-based pricing.
- Don’t promise ‘technology’ as an amorphous panacea but focus on the most proven and relevant solutions. Investment in data infrastructure to achieve risk stratification and case management will be vital if the NHS is going to be able to succeed in the shift to population health management.
- Be honest with the public about the need for us to share data in order to use artificial intelligence (AI) and machine learning, which can then help target those most at risk. Once the NHS has these systems in place it will be possible to target resources directly at those with the greatest need – even if that means that others will have to wait a bit longer for support. This is especially important in primary care and may require changing the current access arrangements that have governed General Practice since 1948.
The Long Term Plan is rightly seen as a major opportunity for the NHS to set a new course to deliver greater value and better health outcomes. Yet it will also involve difficult choices, particularly given the financial starting position of the health service. As the plan is being finalised, ambition must be matched with realism, whilst the desire for transformation and innovation should be linked to securing an appropriate share of the new investment.
Mike Farrar is a Senior Adviser at Hanover Communications and former Chief Executive of the NHS Confederation.