Future options for the NHS


Steve Iliffe & Richard Bourne, for the Health Matters seminar group

In the run up to the 2015 general election, the NHS is likely to have a significant part of its community health services (and some hospital services) provided or managed by the private sector, even though the privatisation process is running more slowly than the government would like.

Clinical Commissioning Groups (CCGs), which became the local purchasing organisations for the NHS in April 2013, will be struggling to balance rising demand for services and expectations and shrinking budgets, but will have limited powers.

Despite the political rhetoric from government about ‘liberating’ the NHS from central control, there will be increased effort by the central administration (now called NHS England) to manage (and micro-manage) the health service, and promote more efficient organisations of services.

We will hear much about service ‘fragmentation’ and the need for ‘integration’. The economic instability of NHS hospital and community services, combined with unachievable savings targets, will undermine these efforts, and top-down management will fail more often.  The denigration and demoralisation of staff will continue.

Financial instability in the hospital sector will increase, being worse where there is Public Finance Initiative (PFI) debt.

Despite the generally accepted need for change every local attempt to reconfigure services, by whatever route, will be robustly contested.

Social care provided by local government is now restricted to those with limited financial resources, and the availability of publicly-funded social care will shrink further. Individuals trying to manage their own social care by using the benefits system will be challenged by benefits cuts and restrictions, even as political rhetoric emphasises ‘personalisation’ and ‘personal budgets’.

There will be more public engagement with the NHS, through both official channels, like the NHS consumer body, Healthwatch and the local government Health & Wellbeing Boards, and unofficial ones like campaigns to preserve existing NHS hospitals and community services.

Public debate about the NHS will be dominated by exposure of scandals by the right-wing press, and to a lesser extent by shroud-waving campaigners defending local institutions. Catastrophists will warn about the imminent downfall of the health service, whilst vested interests in the insurance industry will press for a system change, replacing funding from central taxation with compulsory health insurance on the French or German model.

The background rhetoric of the Government is likely to be that the previous administration failed to take the actions necessary to make the NHS safe and sustainable and that the current government has, and will continue, to root out the poor quality care and to deal with it.

So what will a Labour government be able to do with the NHS, in 2015?  Read the predictions and proposals in the April edition of Soundings