Reform Bulletin

30 April 2008

Bulletin - 30 April 2008

Demand for a new era: The future of health

Reform today publishes a new health report.  Demand for a new era: The future of health is available online at www.reform.co.uk and was launched at a seminar at No 11 Downing Street.

The report by Nick Bosanquet, Professor of Health Policy at Imperial College London and Consultant Director of Reform, Andrew Haldenby, Director of Reform, Helen Rainbow, Senior Research Officer at Reform, and Michael Pullinger, Health Research Intern at Reform, warns that current Government policy will leave the NHS unprepared to meet the challenge of rising demand over the next decade. It finds that the Government’s landmark review of the NHS will balk at the radical reform that would let the NHS cope with trends such as an ageing population and clinical advance. The report shows that the review, under the health minister and surgeon Lord Darzi, can still be of lasting value if it refounds the NHS on a new, economic constitution which guarantees value for money and reform.

The report, details the fundamental challenges that the NHS faces over the next decade, in particular changing demography, advances in medical technology and increased expectations on the part of patients.  It argues that all of those changes are positive but most will drive up the costs of the NHS in its current form.

Ministers have recognised the challenge of rising demand but have ruled out the changes to the structure of the NHS that would allow it to rise to the challenge.  The report shows that Lord Darzi’s fundamental review of the NHS, expected in June, has specifically ruled out structural change that would lead to a reformed service and supported the status quo.

Capable people actively manage their health and lifestyles. Frustration for those interested in their own health as lack ability to make choices. Others not encouraged to lead healthy lives.

Choice

Patients will be able to choose from a range of different service providers as well as methods of service delivery. Limited to certain services, and few patients actually offered it. Lack of easily obtainable information and co-operation by professionals hinders it.

Competition

Will make choice possible and drive up quality. Improve access to services. Services more tailored to individuals.

Lack of diversity of providers, private sector still a very small proportion.

Quality Competition and choice drives up quality of services. Informed patients will not use substandard providers. Wide inequalities remains, compare poorly at an international level.

Shorter waits comparable to those abroad. A wider range of services available in locations and at times convenient to patients. Long waits still remain in many areas. Lack of services in the community.

Positive health outcomes preventing problems occurring in the first place.

Outputs are the objectives. Problems not identified leading to overuse of acute services.

Information

Becomes essential as a range of providers are competing for patients.

Poor information on outcomes. Patients poorly informed when they have to make choices.

Before becoming Prime Minister, Gordon Brown floated the idea of radical change to the NHS.  Since then the Government has spoken of a “constitution” that spells out the service’s “values”.  The Reform authors show that a constitution would be worthwhile if it has an economic basis.  The result would be greater innovation, more choice and less bias towards traditional hospital-based care where so much of the service’s resources are tied up.

The report was launched at a Reform seminar at No 11 Downing Street today.  Its key findings are:

One key theme facing health policy makers is an increase in demand for better health services.  This is due to a number of trends in both society and medicine.  For example:

- on current trends, by 2033 life expectancy will rise by 5 years, but one-and-a-half of those extra years will be spent in ill health;

- cases of cancer will treble between 2005 and 2025;

- the number of people suffering from dementia will rise from 0.7 million now to 1.7 million by 2051; and

- the proportion of males who are obese will rise from 24 per cent in 2004 to 60 per cent in 2050, and the proportion of females from 24 per cent to 50 per cent.

The major funding increases for the NHS have already taken place.  As a result a better service has to be achieved under much greater financial constraints.  What is needed amounts to structural reform of the service, comprising:

- a transition away from monopoly;

- comprehensive service redesign and innovation; and

- a new focus on patient engagement and empowerment.

• Current Government policy accepts the idea of increasing demand but resists the need for structural reform. 
• An essential first step is an economic constitution which will promote a new drive for value.  The commitment to “public value” in the BBC charter could be an interesting model for the NHS.
• The constitution will specify new duties for commissioners.  It will enable use of modern financial reporting and comprehensive service redesign.  It will be the vital step in the move from a provider-dominated service to one in which there is more choice, personalisation of services and improved outcomes.
• The speakers at the No 11 event were Neil Bentley, Director of Public Services, Confederation of British Industry, Tom Nawojczyk, Chief Executive, In4tek, Hugh Risebrow, CEO, Interhealth Canada (UK) Ltd, and Bryan Stoten, Chairman, The NHS Confederation. The event was chaired by Reform’s Consultant Director, Professor Nick Bosanquet.
• The discussion revolved around the demands that will be placed on the service as a result of increased population and consumer pressures. A number of issues were highlighted, these included the major problem of low staff morale, a lack of a failure regime within the NHS, the fact that there is an unfair playing field for the private sector particularly in areas such as pension liabilities and difficulties with the current commissioning process. However, overall the discussion was very positive and it was felt that there are the resources within the NHS to solve these problems.

For more information, please contact Helen Rainbow at Reform.