Difficult conversations about the future of health and care

The annual Summit hosted by the Nuffield Trust is a precious opportunity for a broad range of influential stakeholders to briefly step away from their busy lives and together consider the main policy challenges facing the UK’s health and care systems. The event attracts innovators and disruptors, people who like to listen and like to challenge. The speakers work with the participants, using research evidence and critical analysis, to develop solutions which bridge the gaps between what policy-makers, politicians and academics do and what front-line managers and clinicians do.

Each year since the pandemic, we’ve heard claims that the NHS and social care are struggling like never before and the last year has been no different. The response of the government is to launch a new 10-year plan – the third major system reform in the last two decades. One of the key questions this time is whether these reforms, framed around three “shifts” – of hospital to community, cure to prevention and analogue to digital – can be implemented without significant additional funding. The front-line staff who I speak to say they can’t. The Treasury says they have to be, given the state of the national economy and competing priorities.

The financial crisis

But NHS finances are in crisis. The implementation of reforms requires investment, particularly in organisational development and infrastructure and to enable double-running of established and new services where this is necessary. The needs of a growing and ageing population with increased morbidity and the introduction of new technologies can’t be met within current budgets.

Trust finances are in the midst of the longest decline in a decade, and deficits may go into freefall if the proposed settlements for the next financial year are imposed. General practice and other primary care services don’t have the resources to deliver what the public expect nor what the wider system needs.

Across all services, we will see what we always see – committed, value-driven staff working harder, innovating, taking more risks to keep the service running. They are being asked to deliver more, but when that ask is against a backdrop of tight resources and greater patient expectations, both staff and the public will feel they are delivering less.

The reality of this financial crisis will hit the workforce at about the same time as the launch of the 10-year plan, and shortly afterwards risks hitting patient care in terms of access to services, quality of care and perhaps even safety. This isn’t a good time to demand more of services which in places are on their knees.

Key challenges looking for solutions

So even for committed optimists, there is no sugar coating the pill. Radical change in the ways in which health and care systems work is necessary, but the context in which this change will be happening has never been more demanding.

That’s why bringing decision-makers together at the Summit is so important. Some of the sessions will address familiar and enduring challenges. System reform is rightly top of the agenda for the government, so we’re delighted to welcome Sally Warren, Director General of the 10-year plan, to outline progress ahead of the plan’s publication in a few months’ time. We all know that the ‘what’ of reform is easier than the ‘how’, so the session led by Thea Stein, Chief Executive of the Nuffield Trust, on the psychology of change will be eagerly anticipated.

Another enduring challenge is how to get the best out of the medical profession, in particular the role played by contracts. Nowhere is this more complex than for general practitioners, whose independent contractor status has been a source of debate since Nye Bevan reluctantly signed off the first contract in 1948. The session led by Dr Becks Fisher, Director of Research and Policy at the Nuffield Trust, and featuring Dr Katie Bramall-Stainer, Chair of the General Practitioners Committee at the BMA, will provoke a lively discussion.

There is a temptation for policy-makers to focus on concrete issues like structures, resources and governance, but the provision of care is underpinned by deep moral and ethical conundrums – that’s why initiating change is not straightforward. The Summit doesn’t shy away from surfacing some of these, with sessions on racism, on continuing health care and on end of life care, and we are delighted to be hosting BBC Radio 4 for the first time for a recording of Moral Maze about the ethical purpose of the NHS, to be broadcast in mid-April.

So, an exciting agenda offering hope for the future. Whether you join in person or follow the live-stream on our website, I hope you enjoy the Summit and pick up new ideas and renewed energy to develop them.

Professor Martin Marshall CBE is the Chair of the Nuffield Trust.

The Nuffield Trust Summit takes place on Thursday and Friday this week (March 6-7). You can register to watch the live-streamed sessions. More information about the event can be found here.