Extra spending on the NHS throughout the 2000s may have helped the service to sustain its performance during the more recent period of financial austerity, but influential figures such as Lord Darzi admit that the resources might also have reduced the need for urgent reform, arguing that: 'we missed the best opportunity in the history of the NHS to actually reform it… we just threw money at it.'
NHS England Chief Executive Sir David Nicholson appeared to concur, conceding that the additional investment may have 'allowed us to subsidise poor care when we shouldn’t have done.'
Their remarks are contained within a new volume published by the Nuffield Trust to coincide with the 65th anniversary of the NHS (5 July 2013).
Edited by Nicholas Timmins, Nuffield Trust Senior Associate and former public policy editor of the Financial Times, the publication features essays and interviews with senior individuals from the worlds of politics, medicine, academia and journalism. Among the contributors to The wisdom of the crowd: 65 views of the NHS at 65 are:
- Ten former Secretaries of State and current MPs and Peers, including Norman Lamb, Stephen Dorrell, Andy Burnham, Baroness Shirley Williams, Lord Darzi, Ken Clarke and Alan Milburn;
- Current and former senior officials from the Department of Health and new bodies such as NHS England, Monitor and the Care Quality Commission, including Sir David Nicholson, Sir Malcolm Grant, David Behan, Dame Sally Davies and Sir Bruce Keogh;
- Medical leaders such as Dr Clare Gerada, Dr Mark Porter and Dr Peter Carter, as well as key managerial figures such as Mike Farrar;
- Prominent patient representatives and NHS observers, including Jeremy Taylor, Dr Katherine Rake, Robert Francis QC, Ben Page, Roy Lilley and Dr Neil Bacon.
If there was considerable uncertainty about the NHS' future, there was a profound, almost unanimous, degree of certainty about what needs to be done.
Nicholas Timmins, Senior Associate, Nuffield Trust and report editor
The collection, supported by PwC and the Health Service Journal, comes five years after a previous exercise undertaken by the Nuffield Trust ahead of the health services' 60th anniversary.
In the intervening period, the prolonged economic crisis has led to a major reappraisal of public spending, with far more profound implications for the NHS than anything envisaged by participants at the time of the last such review.
Commenting on the publication, Nuffield Trust Chief Executive Dr Jennifer Dixon CBE said:
'The NHS is facing a watershed moment. The good news is that there seems to be a consensus, at least among contributors to this volume that the NHS should continue as a comprehensive service, free at the point of use.
'There is also broad agreement on what needs to be done. The big issue is how. Those at national level cannot see all the answers – a healthy future for the NHS must mean a completely new relationship between the public, the front line, the strategists and the politicians to forge the right way ahead. The challenge is formidable but there is enough talent and will to face it well.'
Report editor Nicholas Timmins, who interviewed many of the contributors, said: ‘if there was considerable uncertainty about the NHS' future, there was a profound, almost unanimous, degree of certainty about what needs to be done.
'Read through these contributions and a formula emerges. That what the NHS needs is more specialised care in fewer specialist centres, a smaller hospital base, more surgical 'factories' for elective operations in lower-risk cases, much more care at home or closer to home, patients more empowered to take control of their own care, much closer integration of health and social care, and far greater transparency on clinical outcomes and patient satisfaction to drive the argument for all of that and to raise quality.'
Participants appeared further from consensus on how to achieve these goals, in particular over who should be responsible for making the arguments for service change with the public.
Others suggested that the delays to much needed reform were in part due to the NHS having in past years coped well with the ageing population, whilst only recently had pressures on the hospital sector become more severe as more patients were admitted who could in fact be cared for more appropriately elsewhere.
Individuals such as former Secretary of State for Health Alan Milburn argued that what 'is absolutely missing is the long term explanation of how we are going to get there.'
Sir Malcolm Grant, NHS England Chair, outlined plans for a three, five and ten year appraisal of 'how we get from where we are to there with a declining budget', including change programmes that go beyond the life of any one Government.
This publication is a special edition of the Nuffield Trust's Viewpoint series, which provides a platform for UK and international health leaders to explore, discuss and debate health care reform issues.
Notes to editors
- To mark the NHS’ 65th anniversary the Nuffield Trust is carrying out a number of activities to promote debate and discussion on the current state of the NHS and its prospects for the future. Much of our focus is on providing analysis, commentary and debate on how the NHS and social care system can best respond to the challenges ahead.
- This publication is supported by PwC. PwC provides assurance, tax and advisory services to the public sector, including a specialist practice in health care. In 2013, PwC is working with people across the health service and the public to debate what the NHS will – and should – look like in 10 years’ time.
- Our media partner for this publication is the Health Service Journal (HSJ). A selection of the interviews included in the report are published on the HSJ website.