The trauma of radical reform will take time to address, but the future wellbeing of the National Health Service depends on further responding to demographic challenges, writes Martin Barrow
It should be a time to rejoice: people are living longer, surviving diseases for which there used to be no cure. Despite relentless financial constraints, the NHS continues to perform at an astonishingly high level: it treats more people than ever before and carries out more procedures. Mortality rates are in decline and British hospitals are among the safest in the world. It is an extraordinary achievement by a service that has undergone a massive reorganisation and cut thousands of jobs at the same time.
And the Francis Inquiry into the avoidable deaths of hundreds of people at Stafford Hospital exposed a degree of abuse and neglect that has undermined public confidence in the doctors and nurses to whom we entrust our lives in our hour of need.
The inquiry has rocked the NHS at the worst possible time, when it was coming to terms with the most wide-ranging reorganisation since it was founded in 1948. The controversial Health and Social Care Act 2012 has transformed the structures of the NHS, with many of the changes coming into effect on April 1.
While patients may have noticed little change in the way services have been provided since then, they should be in no doubt that the reforms are far-reaching and will pave the way for further change over the next few years. The implications for businesses that provide goods and services to the NHS are equally profound.
The Act abolished primary care trusts and strategic health authorities, two tiers of management that were at the heart of the old NHS. In their place were created hundreds of new clinical commissioning groups (CCGs), led by GPs, to manage primary care with responsibility for billions of pounds of healthcare funds.
It may take years before we will know whether these dramatic changes have the desired effect
These new CCGs will work with patients and healthcare professionals in partnership with local communities and local authorities. The Act effectively transfers responsibility for health services to groups of people who are closest to their local communities and understand their needs and aspirations, and the best way to deliver care. In theory, CCGs can choose how and where they buy services: if one hospital fails consistently to provide appropriate standards of care, the CCG is free to send patients for treatment elsewhere. The intention is to raise standards and secure better value for taxpayers’ money.
One further change brought about by the Act was the transfer of responsibility for public health from the NHS to local authorities, under the supervision of a new body called Public Health England. County councils and unitary authorities now take the lead in improving the health and wellbeing of their populations; they are now charged with reducing obesity levels and the number of smokers, and will commission services for drug and alcohol dependency, for example. Billions of pounds have been transferred from the NHS to be used to address the greatest needs in their communities.
It may take years before we will know whether these dramatic changes have the desired effect. Because the health service is also in the process of achieving savings of around £20 billion before the next election, it will be difficult to determine whether reorganisation or austerity has had the most profound effect. And to create even more uncertainty, the Labour Party has given a commitment to repeal the Health and Social Care Act should Labour come to power after the next election.
One thing is certain and that is the NHS must find new ways to deliver healthcare if it is to survive. Technology must be at the heart of that innovation, as clinicians seek alternatives to current service provision, improving patient outcomes, while working within the toughest financial constraints.
They must collate and exploit more data, to target treatment in the most effective way through the increased use of personalised medicine. Hospitals are under enormous pressure to achieve efficiencies through improvements in procurement and stock control. More patients will be treated in the community and their own homes, through the use of digital technologies to deliver medication and monitor patients’ wellbeing.
Many challenges lie ahead, for patients and clinicians, and the businesses with the technological know-how to transform the delivery of care. They must find ways to work together, overcoming any barriers that are put in their way. For what is at stake is the very survival of the NHS. The failure to embrace technology will condemn the publicly funded health service to terminal decline.