Reflections on the summit: a narrative for change?

The first day of last week’s Nuffield Trust Health Policy Summit concentrated on the linked issues of quality and finance.

It’s clear we are going to have to improve the amount of the former whilst having less of the latter.

I will return to that issue, but throughout my time at the Summit I couldn’t get away from the idea nagging at me that here we are in the spring of 2013 and now, right now, would have been a great time to launch an NHS reform programme from the Government.

Following Francis there is a growing (if patchy) recognition that something is wrong with our current model of NHS care and it needs substantial reform.

Francis has made 290 recommendations which all surround and try and change the culture of the NHS. He recognises that structural reform without culture change will achieve little. But equally to change the culture there needs to be lots of connected changes to the structure.

Following Francis for the next few months there will be quite a number of front page stories highlighting particular breaches of safety in different parts of the NHS. Sunday 3 March had the front headline of the Express saying that 1125 people die of malnutrition in NHS hospitals. There will be a lot more of this.

Over these next few months, it may well be the case that a further five or six hospitals will be labelled as failing by a combination of public stories and NHS investigation.

At the same time as the Government works through the plans for the next round of cuts in public expenditure, there may be a dawning recognition that ring-fencing the NHS budget over the next decade when everything else is being cut, will simply not work forever.

In the spring of 2013 there is a growing case for substantial reform of the NHS that clearly tackles safety and quality and also significantly improves value for money.

The narrative for radical change is strong and clear.

Jeremy Hunt’s speech at the Summit was a clear example of how a reforming Government could, given these conditions, develop a narrative for radical reform of the NHS. He was attacking mediocrity in the NHS and calling for ambition and improvement. This looked like a good start for a reforming narrative.

The problem is that the Government launched its reform programme 32 months ago when no one was suggesting that there was a need for NHS reforms. And now they are stuck with a set of reforms that don’t really have any bearing on these new set of issues that have now become clear.

Why Andrew Lansley launched a programme of reform of the NHS at the time of the Francis Inquiry that would when it reported need to have a further programme of reform in two years time was a genuinely strange thing to do.

If he had waited two years to launch his reform not only would he still be Secretary of State for Health but he would also now have a narrative on which to build a reform programme.

That will remain one of the many mysteries about his time as Secretary of State.

The Summit’s first session consisted of a set of talks from economic people most of which NHS people would never really get a chance to listen to.

Starting with the International Monetary Fund (IMF) and going on to the OECD and an ex member of the Bank of England’s Monetary Policy Committee, there was a series of analyses of the world economy and its impact on the health service that provided a master class in the incontrovertible fact that however big the NHS, the issues around the world economy dwarf it.

The IMF recognises that in the developed countries there will be an increase in fiscal demand caused by an aging population. They reckon that between now and 2030 the cost pressures on GDP caused by increased costs associated with pensions will be about an increase of one per cent of GDP.

However the cost pressures concerning the ageing population that are associated with increased demand for health will be three times as much.

As they said it is difficult to see how over the next 18 years or so population in countries such as the UK will agree to the substantial increases in taxation that will be necessary to meet this increased demand for resources for the NHS.

Andrew Sentance, ex from the Bank of England Monetary policy Committee (the group that sets interest rates) gave a talk called The new normal. He underlined that it would be difficult to see a return to the years of growth in the British economy and that the new normal was little growth and very tight money. 

And whilst this is not directly relevant to health he had one of the most important counter-intuitive slides I have seen. Instead of concentrating on the problems of the UK economy in isolation, he looked at the growth of the size of the world economy between what it had been from the year 2000 to what it could be projected to be in the year 2017. 

This was one of the most significant set of statistics I had seen in the last decade because it showed that between 2000 and 2017 the world economy will increase in size from 23 trillion dollars to 93 trillion dollars.

I know these are very large sums, but it means that over 17 years the annual amount of wealth produced in the world will increase nearly three times.

This is a fact of massive importance to the world economy. The economic troubles of the UK are put into perspective by the massive growth, although it does make the harsh case that the world economy is growing very fast, and we are standing still. This means that whilst it may appear that not growing at all is very difficult for us, in effect it is a lot worse.

And unfortunately I still don’t know where those people who think there will be more money for the NHS think that money will come from.

Professor Paul Corrigan is an independent consultant and currently Adjunct Professor of Public Health at the Chinese University of Hong Kong and of Health Policy at Imperial College London. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors' own.