Election 2015: The King’s Fund’s hopes for the future of the NHS

The King’s Fund is an independent charity working to improve health and healthcare in England. As part of our General Election coverage, we asked Catherine Foot – their Assistant Director of Policy – for her organisation’s opinions on what the next government’s health policy should look like.

The next election is too close to call. But already, the NHS has been at the heart of a great deal of campaign discussion – particularly the thorny issue of how to fund the NHS and integrate it with social care.

However these issues are solved, the next Government must focus on improving the quality of care for patients. Its challenge will be to transform services in order to meet the needs of patients in the 21st century.

So how can this happen? At the King’s Fund, we feel there are four key priorities – improving productivity, increasing funding, improving quality and reforming the system.

Improving productivity

The NHS needs to do more with the resources it has. In other words, it needs to improve its productivity. Good progress has been made in recent years. Savings have been made by limiting staff salary rises, reducing the prices paid to hospitals for treatment and cutting management costs – but these options have now been largely exhausted.

Other money-saving options must now be used, these include:

• a stronger national focus on collating and disseminating good practice in improving efficiency
• more emphasis on encouraging clinicians to lead changes in clinical practice that improve care and reduce costs
• stronger leadership at a regional level to plan and make these changes
• more sophisticated approaches to incentivising NHS organisations to improve efficiency

Additional funding

Improving productivity won’t be enough on its own to avoid a financial crisis. Unless significantly more money is found, patients will suffer as staff numbers are cut, waiting times rise and quality of care deteriorates.

And it’s absolutely vital that new funding isn’t spent simply propping up unsustainable services. Instead, it should be used to meet the cost of essential changes to services, and to ensure that care is better co-ordinated around the needs of patients.

As such, we think the next Government should establish a ring-fenced health and social care transformation fund, to be used to develop new community-based services and to cover double-running costs during the transition between old and new models of care.

Improving quality

The shocking failures of care at Mid Staffordshire NHS Foundation Trust, outlined in the Francis report, marked a watershed for the NHS, refocusing it on its core purpose – providing high-quality care.

The report has led to a major overhaul of the hospital inspection regime, a new ‘duty of candour’ (requiring staff to report instances of poor care), and a number of initiatives to make more information available to the public about the performance of services. Meanwhile, hospitals have responded by recruiting additional staff to boost staff–patient ratios.

Much of this is a good step forward, although it remains to be seen whether hospitals will be able to sustain staffing levels in the face of financial pressures.

But it’s important to be realistic about what can be achieved by regulation. The first lines of defence against poor-quality care aren’t rules. The culture of an organisation is the most important influence on the ability of its staff to deliver high-quality, compassionate care. This means creating a culture in which patients come first, and openness, transparency and accountability are the norm.

This will be a long haul. The job for the next Government will be to ensure this type of culture is developed and adopted across the NHS. And the local leaders responsible must be supported throughout the process in order for these changes to be maintained.

Also, a shift is needed to involve patients much more closely in decisions about their care. It’s time to make shared decision-making between doctors and patients a reality; when patients are fully informed about their options, they often choose different, and fewer, treatments.

While not appropriate for all patients, the new personal budgets make care more personalised and could be used more widely. The NHS should make better use of data and technology to support patients in managing their own care.

Reform

As a country, our needs have changed dramatically since the NHS was established in 1948. We’re living longer, healthier lives and huge progress has been made in reducing early deaths from the biggest disease killers, including cancer.

But despite these changes, the NHS remains a service that diagnoses and treats sickness, instead of one that predicts and prevents it.

This needs to change. Care needs to move out of hospitals into the community, and more focus is needed on prevention. And this needs to be supported by a long-term commitment to improving the population’s health, with local authorities using their new responsibilities for public health to lead the way locally, supported by government regulation where necessary.

In practical terms, this means tackling obesity, reducing alcohol-related health problems, and addressing persistent inequalities in health between rich and poor. We must never forget that four out of 10 cancer cases could be prevented if we all led a healthy lifestyle, while 19,000 cancer deaths could be avoided if we closed the inequality gap.

On top of this, the UK population is ageing, and more of us are living with a chronic condition.

If we’re to meet this challenge, services will need to work much more closely together to provide care co-ordinated around the needs of the individual.

To deliver integrated care at scale and pace, the next Government should focus on removing the barriers that stand in its way. This should include:

• addressing the fragmentation of the way care is commissioned across the NHS
• tackling perverse financial incentives in the way that services are paid for
• and ensuring the drive to improve efficiency through competition does not hinder collaboration between services.

Ultimately, we need to end the historic divide between the health and social care systems by moving to a single, ring-fenced budget, and a single local commissioner of services.

The election is now just two days away. These are all substantial challenges for whoever ends up the winner – or more likely, winners. But they’re challenges that need urgent solutions if we’re to keep the NHS on track.

Catherine

• This post draws on The King’s Fund’s ‘Priorities for Next Government’, which is available here.

Image

• NHS bike image from Flickr, under CC BY-NC-SA 2.0