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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Reflections on the Nuffield Summit

Filed Under (Economics, Narrative of reform, Reform of the NHS) by Paul on 13-03-2013

The first day of last week’s Nuffield Health summit concentrated on the linked issues of quality and finance. We are going to have to improve the former whilst having less of the latter. I will return to this issue.

Throughout my time at the Summit I couldn’t shake off the nagging idea that, here we are in the spring of 2013 – and right now would have been a great time to launch a Government NHS reform programme.

Following Francis there is a growing (if patchy) recognition that something is wrong with our current model of NHS care and that it needs substantial reform. Francis made 290 recommendations all of which surround, and try to change the culture of the NHS. He recognises that structural reform without culture change will achieve little. But equally to change the culture there needs to be many connected changes to the structure.

Following Francis there will, for the next few months, be quite a number of front page stories highlighting particular breaches of safety in different parts of the NHS. (On Sunday March 3rd the Express carried a main headline saying that 1165 people die of malnutrition in NHS hospitals. There will be much more of this). Over the next few months it may well be the case that a further 5 or 6 hospitals are labelled as ‘failing’ through a combination of public stories and NHS investigation.

At the same time as the Government works through the plans for the next round of cuts in public expenditure, there may also be a dawning recognition that ring fencing the NHS budget, when everything else is being cut, will simply not work forever.

In the spring of 2013 there is a growing case for a substantial reform of the NHS that clearly tackles safety and quality whilst also significantly improving value for money. The narrative for radical change is strong and clear.

Jeremy Hunt’s speech at the Nuffield Summit was a clear example of how a reforming Government could, given these conditions, develop a narrative for radical reform of the NHS. He was attacking mediocrity in the NHS and calling for ambition and improvement. This looked like a good start for a reforming narrative.

The problem is that the Government launched its reform programme 32 months ago when no-one was suggesting that there was any need for NHS reform. Now they are stuck with a set of reforms that don’t really have any bearing on this new and obvious set of issues.

Why Andrew Lansley, at the same time, decided to launch both a programme of NHS reform and the Francis Inquiry – that would, when it reported, require an addditional programme of reform two years hence – was a genuinely weird thing to do. If he had waited two years to launch his reforms not only would he still be Secretary of State for Health but he would also have a narrative upon which to build a reform programme.

This will remain one of the many mysteries about his time as Secretary of State.

Returning to the Nuffield Summit. The first session consisted of a set of talks from economists, most of whom NHS people would never really get the chance to listen to.

Starting with the IMF and going on to the OECD and an ex-member of the Bank of England’s Monetary Policy Committee, there were a series of analyses of the world economy and its impact on the health service that provided a master class in the incontrovertible fact that, however big the NHS might be, the issues surrounding the world economy dwarf it.

The IMF recognises that in the developed countries there will be an increase in fiscal demand caused by an aging population. They reckon that between now and 2030 the cost pressures on GDP caused by increased costs associated with pensions will see an increase of about 1% of GDP. However the cost pressures concerning the aging population associated with increased demand for health will be three times as much. As they said it is difficult to see how, over the next 18 years or so, the population in countries such as the UK will agree to the substantial increases in taxation necessary to meet this increased demand for NHS resources.

Andrew Sentance ex-Bank of England Monetary Policy Committee member (the group that sets interest rates) gave a talk called “The New Normal”. He underlined that it is difficult to see a return to years of growth in the British economy and that the new normal was little growth and very tight money.

And whilst this is not directly relevant to health he showed us one of the most important and counterintuitive slides I have seen. Instead of concentrating on the problems of the UK economy in isolation he looked at the growth in the size of the world economy from what it had been in the year 2000 to what it could be projected to be in the year 2017. This was one of the most significant sets of statistics I have seen in the last decade because it showed that between 2000 and 2017 the world economy will increase in size from 23 trillion dollars to 93 trillion dollars.

I know these are very big numbers, but it means that over those 17 years the annual amount of wealth produced in the world will have increased nearly threefold. This is a fact of massive importance to the world economy. The economic troubles of the UK are put into perspective by this massive growth, although it does make the harsh point that though the world economy is growing very fast, we are standing still. This means that whilst not growing at all is already very very difficult for us, it is in fact much worse than that. The world economy is growing very fast and we are standing still.

And I still don’t know where those people who think there will be more money for the NHS imagine it will come from…


One Response to “Reflections on the Nuffield Summit”

  1. Strategically, it’s a socio-political decision what %GDP we spend on healthcare, so some increased funding is achievable (if we so choose: e.g. Trident vs NHS!). It’s important also to include prevention in the wider perspective e.g. influencing lifestyle choices (diet, exercise, smoking, alcohol)has a critical influence on future demand.

    Also, current focus on affordability considers primarily the cost of treatment as delivered by providers steered by commissioners, so putting pressure on frontline care: whereas the ‘system costs’ (transactional, management, regulatory)should be a key target for improvement.

    So the current measure of £bn cost of the NHS needs a wider perspective before future affordability can be ruled out!

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