Reflections on where we are now and where we need or would like to be
Context
• well recognised that NHS is great – commonwealth study said so twice;
• indeed, other countries look to us enviously
• but things have got more difficult since 2010
Our special relationship …
Some high level data – interesting but spurious?
Health Care System Performance Rankings
| AUS | CAN | FRA | GER | NETH | NZ | NOR | SWE | SWIZ | UK | US | |
| OVERALL RANKING | 2 | 9 | 10 | 8 | 3 | 4 | 4 | 6 | 6 | 1 | 11 |
| Care Process | 2 | 6 | 9 | 8 | 4 | 3 | 10 | 11 | 7 | 1 | 5 |
| Access | 4 | 10 | 9 | 2 | 1 | 7 | 5 | 6 | 8 | 3 | 11 |
| Administrative Efficiency | 1 | 6 | 11 | 6 | 9 | 2 | 4 | 5 | 8 | 3 | 10 |
| Equity | 7 | 9 | 10 | 6 | 2 | 8 | 5 | 3 | 4 | 1 | 11 |
| Health Care Outcomes | 1 | 9 | 5 | 8 | 6 | 7 | 3 | 2 | 4 | 10 | 11 |
Source: Commonwealth Fund analysis 2017
There are other challenges ….
Particularly workforce ones
- Demographic ‘time bombs’ in workforce…
- Average 25% vacancies in nursing workforce
- Impact of Brexit – already
- Quality and capacity/capability, too
- Related to funding and available workforce
You need sufficient activity to make it safe and effective so is there an inevitable need for reconfigurations
- A&E/EM
- Maternity and Paediatrics
- Cancer
- CVA & CHD
- Primary care
An interesting question – not least for socialists ….
- When we’re ill, we know where we’d rather be treated?
- We know which GP practice to join?
Or is this just like dilemmas over education:
- Selective education solution?
- Or, all local schools should be good schools?
Current ‘solution’ – STPs/ACOs&ACSs/Integrated Care Systems
- 44 STPs created by stealth – no legislation, and a reluctance to legislate
- A damaged brand
- Political opposition – P and p
Is it about
- Sustainability
- Quality
- Integration
Or is it about privatisation, USA style ACOs & ACSs / HMOs, Any willing provider etc.
Or, have we always had an element of private provision?
Some examples
- Worcestershire and Staffordshire maternity services?
- Birmingham’s health system?
- Coventry and Warwickshire
Coventry and Warwickshire has a combined population of just under 1 million
• 2/3 Clinical Commissioning Groups
• 4 NHS Provider Trusts
• 2 Social Care Local Authorities – Coventry City Council and Warwickshire County Council
• 4 Warwickshire District Councils
• Various system challenges
Concordat between Coventry and Warwickshire Health & Well Being Boards
• Ambition to develop sustainable services and bridge a funding gap of £267M by 2020/21
• Various work-streams, including:
- Stroke
- Maternity services
- A&E/EM
- Governance – political and public engagement
Coventry & Warwickshire Sustainability and Transformation Plan (Better Health, Better Care, Better Value)
Most recent announcement – Integrated Care Systems
Sustainability and Transformation Partnerships become Integrated Care Systems
- National contract
- Commissioners and providers encouraged to collaborate
- Still no statutory basis
- A&E targets loosened till 2019?
- Referral Time to Treat 52 weeks wait to be halved
- Cancer, Primary Care, Mental Health & Learning Disability
Things a Labour Government would need to sort …
- Increase spend as % of GDP – how much?
- (Strong) hypothecation?
- Introduce a national care service or simply implement a version of Dilnot?
- Scrap the internal market and public private partnerships?
- Eliminate differences between foundation trusts and non-foundation trusts?