The Future of the NHS under a Labour Government

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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 …

Trump's attack on the NHS

Some high level data – interesting but spurious?

International comparisons

 

Health care spending 1980-2015

Public spending on health in Europe

Ranking health systemsHealth 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 & 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)

Health and Well being Board Concordat

Governance structure

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?