An audience at the King’s Fund heard Secretary of State for Health Jeremy Hunt set out his ambitions for the reform of the NHS and his vision for healthcare over the next 25 years last week. In attendance was Freshwater’s account director Louise Harris, who gives her prognosis below.
Mr Hunt’s speech, the longest of his political career, coincided with the release of the King’s Fund’s 16th Quarterly Monitoring Report. The latest report contains the results of a comprehensive survey of finance directors at provider trusts and clinical commissioning groups (CCGs) across the UK.
What are the symptoms?
Over 100-plus pages, the King’s Fund report paints a picture of rising costs, increased demand and a growing deficit following funding freezes. Of the acute trusts who responded to the survey, 89% reported that they will overspend their budgets by the end of the year and 40% were concerned they wouldn’t meet the planned cost improvement programmes scheduled for 2014/15.
Government initiatives to reduce costs by cutting dependence on agency staffing fell flat too, with 61% of finance directors saying they were unlikely to be able to shift their reliance from agency staff due to the absence of suitably qualified permanent members of staff entering the workforce. When asked if they think the new order on agency costs will impede their ability to recruit staff who will provide safe care to patients, 28% said yes.
The money is coming, the Government says, in its manifesto, March budget and emergency budget. A further £8billion has been committed to the NHS within this parliament but, with the required NHS contribution to the Better Care Fund all but wiping out any real-term increases, and no details of how and when that money will enter the system, trusts are bracing themselves for flat budgets once again for the year ahead.
What treatment is prescribed?
If you ask the King’s Fund, a healthy dose of cash. The charity advocates a response that front-loads a minimum of £8billion into the system as soon as possible.
Sir Robert Naylor, a chief executive of 31 years, offered his ‘lifelong’ view of the NHS arguing that in fact, it had never been in better health: public support is at an all-time high and other nations look to our shores for innovative and inspirational healthcare solutions. He was pragmatic, however, about the fact that none of this affords our ‘national religion’ protection from what he describes as a ‘financial crisis of epic proportions’.
Describing the Five Year Forward View as a compass, rather than roadmap, Sir Robert called for a clear plan that ‘we can all understand and get behind’. In his opinion, procurement efficiencies, better medicine management and staffing controls will only scratch the surface.
Jeremy Hunt focused on the concept of ‘intelligent transparency’: on the idea of a health system which has intelligent conversations with the public and their role in their personal wellbeing. He talked about a health system which openly reports failings and challenges the NHS orthodoxy of keeping issues private for fear of damaging morale. One which delivers high quality integrated care holistically, not episodically, seven days a week. He spoke of prevention rather than cure; of patients empowered with access to their electronic medical records and of data sharing with GPs to influence care pathways.
What is Freshwater’s diagnosis?
Clearly money really is too tight to mention. With question marks over the social care budgets and the arrival of the promised £8billion, the timelines for the delivery of Mr Hunt’s vision of integrated care pathways are not yet clear.
Whole system communication will be needed in order to secure buy-in to this vision from the NHS workforce: all hands on deck will be needed to deliver the kind of mass cultural and systemic change he is aspiring to. As headlines beckon, the NHS must not ignore dialogues taking place internally or shunt stakeholder communications to the bottom of the agenda.
Furthermore, public health campaigns will be needed to empower and educate the population about their role in maintaining and managing their own well-being to drive forward the prevention agenda.
What remains to be seen now is whether the Secretary of State’s words will be formed into decisive action and confirmation of funding. One thing is clear: change is necessary to meet the increased demands on the service and drive up quality. The scope and speed of that change is now on the table for debate. As Sir Robert aptly put it to the audience at the King’s Fund: “If we keep doing what we’ve always done, we’ll only get what we always got.”
Freshwater’s healthcare team has experience of working with NHS Trusts offering services from stakeholder communications to crisis management, events and training.