We must learn from past mistakes to deliver a more efficient NHS
As the Government heads into Budget negotiations and scopes out the post-brexit NHS settlement, now is the time to put the NHS under the microscope.
During the referendum and the General Election, significant promises were made; £350million a week by the Leave campaign; £8billion in real terms by 2022 from Conservatives and a whopping £30 billion from Labour.
Yet much of the political debate on the performance of the NHS and its funding isn’t enlightening or particularly relevant to users of the NHS. A bidding war about how much extra to give the NHS doesn’t deal with its two main challenges.
First, the issue of safety and quality of care and second, how the money invested is spent efficiently. These are the two issues that matter because they relate directly to patient experience and the outcomes that result.
Labour bequeathed the NHS with some hospitals in a shocking state, so Conservatives rightly focused on safety and quality of care. Jeremy Hunt ensured a top-class independent inspection regime that made sure failing trusts, GP surgeries and care homes went into special measures.
These measures have made the NHS safer and the number of patients suffering anything from falls in care to pressure sores have dropped. MRSA rates halved to the lowest in Europe, many survival rates hit a record high and in-patient satisfaction ratings have soared. In a service under pressure this is remarkable and a tribute to the work of the front-line staff. But it’s not perfect. A report from Prof Tim Briggs and John Abercrombie shows there are still huge variations in both the cost and quality of routine treatments.
Which brings me to the second issue: efficiency and funding. Despite improvements, much of the extra funding into the NHS has not been successful in reaching the frontline. While the public generally want more spending on the NHS, they are clear that there is also significant waste.
The Briggs/abercrombie report confirms continuing levels of waste. Things could and should have improved further with the money pumped in and the NHS needs to learn from past mistakes if another slice of taxpayers’ money isn’t to be frittered away.
Since 2010, real terms funding increased at 1 per cent a year, compared with a more usual 4 per cent. Thanks to election pledges, negotiations over the Budget and Brexit will probably end austerity in the NHS. But we also know from the experience under Tony Blair and more recent investments, the NHS can’t
‘While the public generally want more spending on the NHS, they are clear there is also significant waste .’
cope with big spending splurges.
The Wanless Review of 2007 found that almost half of Blair’s huge additional investment simply went in higher pay and prices. The 2015 increase has been no more successful and has seen a ballooning of NHS trusts deficits. Is the NHS therefore capable of spending additional funding efficiently so that patients benefit in proportion to taxpayer investment?
The answer is probably no, so two things need to happen on which the Treasury and Jeremy Hunt must insist.
First, while efficiency gains have been made, there is still more to do and protests about efficiency savings being “unrealistic” should be ignored. In funding negotiations government must insist that efficiency improvements continue to be a top priority for NHS management.the Briggs/abercrombie report gives many examples of inefficiencies including; more than 300,000 patients a year admitted to emergency surgery beds when no operation is required; hospitals spending £23 million a year by keeping in-patients too long; varying infection rates for hip and knee replacements that could be brought down, saving up to £300million a year. Second, the NHS has started looking seriously at workforce planning, and the investment in additional medical school places is a good start. But the release of new funds must be founded on a comprehensive Workforce Plan, so money goes into additional doctors and nurses not agency staff or wage inflation. Brexit is both a risk and an opportunity, as it may make it harder to recruit from the EU, but equally it should force the NHS to plan to train our UK workforce.
The next six months are an important opportunity for a Conservative government to use new NHS funding to ensure big improvements in patient care. It would be madness not to learn from past mistakes and deliver a more efficient, productive and focused NHS.
Rob Wilson is the former Tory MP for Reading East