It’s not all about the money

Our chair Andy McKeon gives his thoughts ahead of today’s health policy summit, which will bring leaders and experts together to rethink the biggest issues in health and social care.

Blog post

Published: 01/03/2018

Everybody, even Donald Trump, agrees that the NHS needs more money. The Nuffield Trust’s own financial analysis has laid out the scale of problem. And there is no shortage of advice or literature about how much will be needed in the next 10-15 years. More money will surely come. But history suggests it will come with change and strings attached. We need to prepare for this, and to answer the basic question of how would you spend the money – more of the same, investment in specified areas, or changes in the way care is organised, delivered and paid for? We won’t be successful in this unless we are prepared to see things differently, which is the theme of this year’s Summit.

We won’t therefore have a session specifically on the finances of the NHS and social care, although I am sure they will come up in conversation. Instead we will explore what sort of changes we might like to make in some key areas – focusing on how care is delivered, drawing on our research and others’ expert knowledge to enable us to see things differently.

A packed and varied programme

Let’s start with A&E and acute medical inpatients, about which we hear so much and are a touchstone for many about the state of the NHS. Dr Louella Vaughan and colleagues have been examining how acute medical care is organised and delivered in similar hospitals. The results are sometimes surprising and point the way to a better approach.

And move on to social care, where the focus has been on funding by the state or funding by individuals. Less attention has been given to what is actually provided. So the Summit will look at what is happening to provision and what should it be like in the future, drawing on views from leading academics and care providers.

The issues facing the NHS workforce are at least as significant as its finances and more difficult to fix – finances after all can ultimately be fixed by simply signing a cheque. No similar magic wand is available to resolve the workforce problems. Led by Candace Imison, we will consider whether and how we can improve workforce planning – starting with the thought that perhaps it isn’t possible effectively to plan the workforce.

Primary care and outpatients are the two areas where most people experience the NHS. Rising demand, financial pressures and workforce shortages together require some rethinking of how they are organised and how care is delivered. The Summit will address both.

Public perceptions

All of the above might seem a little inward looking – health and social care experts and practitioners addressing their own problems in their own way. So, to set some context and broaden detailed service-focused horizons, John Appleby will take the temperature of the public through the results of the latest British Social Attitudes survey.

Levels of public satisfaction with the NHS ought to be a powerful indicator for politicians, and can’t be dismissed as ‘fake news’ even if some might like it to be. But in this ‘post-truth age’, trust between politicians, institutions and the public – essential to the future of the NHS – may be in short supply. We will have Matthew D’Ancona to guide us through the political and social landscape we now face.

No conference would be complete without having an insight on services from a patient’s perspective. We will take a different slant on this, looking at what happens when NHS staff become patients and how this changes – or should change – their approach to their profession and how care is organised and delivered.

If you think this is still too parochial and we need to look internationally for inspiration and guidance, we can help there too. Too often in my view conferences, and policy-makers, only look to the United States for ideas when the culture and organisation of care are so radically different they make transference almost impossible. Looking closer to home might prove more fruitful, so we have a session on quality improvement drawing on Swedish experience – a different culture certainly but closer in values and organisation than those of America.

Big birthday year

Finally, we will be hearing much about the NHS’s 70th birthday this year. We ought not to forget that 1948 was also the year of the National Assistance Act – ‘an act to terminate the existing poor law (Tudor in origin) and to provide in lieu thereof for the assistance of persons in need by the National Assistance Board and by local authorities; to make further provision for the welfare of disabled, sick, aged and other persons and for regulating homes for disabled persons…’

The founding of the NHS was indeed just one response to one of Sir William Beveridge’s ‘five giants’ – squalor, ignorance, want, idleness and disease. The giants have been reduced in size. But they are still with us and have a profound impact on the NHS. Nick Timmins, author of The Five Giants: a biography of the welfare state, will lead our discussion on the welfare state today – how the five giants continue to affect the NHS and what the responses should be after 70 years of experience.

Nigel Edwards will as usual be drawing it all together. And Simon Stevens will devote his session to answering questions about current issues and where we go from here.

Whether you are there or following on the live stream on our website, I hope you find the sessions as interesting and insightful as I will.

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