Conrad Bannister is an Associate Researcher in healthcare policy at the think tank Bright Blue.
Keir Starmer’s Government had recently commissioned Lord Darzi to produce a paper on the current state of the NHS.
Unfortunately, it is far too similar to far too many reports that have gone before. It points out how poorly the NHS is delivering for patients, with long waits for A&E, elective care, and most other types of care. It points out that the UK has underinvested in infrastructure and community care. And it points the finger primarily at austerity. Colour me surprised.
Of course, more money would always help. Just about any cause area would be helped by more money being committed to it, but, at a time of record-high tax levels and government debt, the state must try to be efficient with its expenditure.
Yet the UK already spends more on healthcare (11.3 per cent of its GDP) than almost all our European peers. Even accounting for purchasing power, we spend more than Italy and Spain, and the same as Finland, all in exchange for worse life expectancy. The British die sooner and receive poorer quality treatment than most similarly developed European countries.
This means that Lord Darzi is wrong. The UK’s healthcare problems go deeper than money.
Headlining austerity distracts from the real problems, some of which Lord Darzi touches on. The NHS should be able to take a long-term view and shape local services to improve efficiency, and yet it is hopelessly short-termist and fails to implement simple changes, such as stroke care centralisation or a shift to more community care. But the real problem is not a lack of funding; rather, it is that the NHS has tied the hands of its regional headquarters: Integrated Care Boards (ICBs).
These ICBs are supposed to drive improvement, execute local strategy, and think for the long term about what their patients need. Alas, the huge amount of central direction from the NHS, coupled with a consultation system opposed to change, blocks even improvements that could save money and lives.
In my healthcare policy research, I have repeatedly heard that much of the money given to ICBs was hypothecated, or very tightly specified, and only given with certainty over short periods – often less than twelve months. This meant that investments in new IT systems or in improving prevention, which could save both money and lives at greater efficiency over the long term, were often impossible to make. Spending more money this year to save the next is not an option.
An upcoming Bright Blue report calls for devolution of real power to ICBs. This means not giving them more money, but giving them control and certainty over the money they do have. This would allow them to do things such as spend more money on community care to keep elderly patients out of hospitals – rather than more money on hospital geriatricians – or invest in a new IT system, knowing they have the budget to commit to it for the next few years.
Preventing problems before they occur or addressing them in the community rather than in hospitals is often tens of times more efficient in the long run in terms of expenditure, but currently the NHS is over-prioritising short-term results.
The NHS as a whole, and ICBs in particular, must become less obsessed with short-term operational metrics – especially hospital ones – such as the four-hour A&E target. These drag attention to the symptoms rather than the causes of problems.
A patient-outcome-focused scorecard, including metrics such as mortality and patient satisfaction, would hold ICBs to account for the things that matter and, crucially, allow them to adapt to local conditions to deliver. We know that currently never-ending micromanaging dictates and data requests from NHS headquarters not only suck up management time but also prevent changes that make sense to everyone on the ground yet do not fit into the national programme.
There is another elephant in the room: real improvements create winners as well as losers. Empirical research shows that larger, more specialised treatment centres – for example those treating strokes – are less expensive and save more lives than having many small treatment centres. London and Manchester have already made the change to consolidate stroke care under a smaller number of centres demonstrating the benefits, but not everyone has.
The consultation process – asking local communities about changes that affect them – makes any changes that might close or repurpose a ward – in other words, any meaningful change – very difficult. It can add 18 months to the project on top of uncertainty and politicisation. How can we be surprised that the NHS is unable to improve productivity when leaders avoid changes that might trigger the consultation process?
The process must be streamlined to allow clinically justified changes to happen much faster. ICBs should know that service changes that will save lives and reduce costs will not be blocked by local pressure groups as opposed to ever closing or repurposing a ward at their local hospital to keep things in their favour in the short term.
The Darzi report missed an opportunity to do more than identify problems and call for more money. It is likely to serve as evidence for the Starmer Government to once again pump more money into the NHS. Without reform, this would be a real mistake.
Since 2019, there has been a real-terms increase in funding for the NHS of 3 per cent a year, yet more doctors and nurses in hospitals has been unable to increase treatment volumes. The obsession with hospitals and short-term outcomes means the extra money is going to waste.
The money that does go into the NHS should be accompanied by reform. It should be clear that patient outcomes – not operational targets – are what each part of the NHS should be pushing towards.
ICBs should be given the real mandate to drive local improvement. That will require giving them money over longer periods, ending the over-prioritisation of hospitals, and – yes! – even sometimes allowing a ward to close.
#Conrad #Bannister #Centralisation #shorttermism #woes #NHS #lack #funding #Conservative #Home