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The NHS and the next 5 years

November 5, 2014

Now is a very good time to think about the future of the NHS over the next five years and its potential interaction with the private sector. The NHS is likely to be a key battleground at the next election. The Labour Party have raised the stakes with their commitment to fund extra staffing through a mansion tax.

Of equal importance is the fact that NHS England are currently engaged in a consultation exercise which they call “the NHS Five Year Forward View” (5YFV). The purpose of the review is to consider why change is needed, what success might look like, and how to get there. They have a series of workstreams. Here are some of them. How we can improve the health of our population and what role the workforce can play? How we can support patients to be more engaged in their own health? What are the new care models that could integrate care and how can we achieve delivery? What benefits can be provided for patients and tax payers? And how can we “future proof” the NHS given advances in technology, innovation and genomics?

All of these workstreams would benefit from ideas and support from the private sector – both private providers and the insurance industry. Income protection and PMI already contribute to rehabilitation and health promotion in the workforce and we need to get actively involved in the consultation. In terms of future proofing the same issues arise for maintaining sustainable premiums for PMI customers as arise for the tax-payer and the NHS.

Underneath these workstreams lie the key drivers for the future of the NHS. Some can be influenced to some extent. Others will require mitigation strategies – future proofing. So what are the key drivers for the next five years?

Simon Stevens CEO NHS England gave a speech in July which gives clues to Government thinking. First is the perennial problem of the push for larger centres of excellence, to give the best possible care, versus the pull for more community services. The “downside” of the pull element sees campaigns to keep local hospitals open regardless of how effective they are. On the “upside”, technology gives the opportunity to provide remote consultations etc from centres of excellence direct to the local community. Second is funding. There has been a 76% increase in FTE hospital consultants since 2000. That is good news but it does simply replicate existing and expensive staffing models. He does not suggest a wholesale reorganisation of medical training and staffing but he does make the very reasonable point that existing models should not determine the future set up. All this still begs the question of where the money is going to come from in the future? How sustainable is it to continue to increase public spending without tapping into possible private funding through employee based schemes. And what about the self-employed? This is a sector that is growing massively, especially for the older workforce.

Finally he spends much time discussing innovation in medicine. A key issue is the potential through genomics to move towards more personalised medicine. From a funding perspective this will bring more and more challenges to NICE. The NHS is never going to be the place where highest prices are paid. Difficult decisions will need to be made especially as personalised drugs are likely to be expensive as they take lots of research to deliver yet don’t treat very large numbers of people.

There is a lot to debate so get involved. Don’t just leave it to the usual health wonks.

Written by Richard Walsh, first published in Cover Magazine, October 2014 (click here for Cover magazine)

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