Where is the oomph?

Blog post

Published: 27/04/2012

With the showers has come a certain malaise tinged with queasy uncertainty.

This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

After the March Budget, our Chief Economist Anita Charlesworth pored over the Red Book finding that about £500 million of the NHS surplus (£1.2 billion by the end of quarter two) will not be reinvested in the service but instead go to reducing the wider budget deficit.

But more sobering was the likely cut in resources to the NHS in 2015 – 2017 (2.3 per cent real terms) and the prospect of needing at least six per cent efficiency savings in order to manage.

Next to this, debates on the mandate, how clinical commissioning groups (CCGs) are developing, how much competition and choice, and how many Trusts have still to make foundation trust (FT) status look arcane.

Far more important must be how much oomph there is in the service to make radical change, scrutinise the quality of care, and sort out the mess that is social care eligibility, funding and provision.

With the Care Quality Commission (CQC) on the ropes and the Francis Inquiry reporting later this year, the whole apparatus to scrutinise quality of care will need to be cranked up in a way that, as yet, the country has not seen – and by weary management as well as doctors.

One glimmer of light is that a whole tranche of data – clinical data from all general practices in England – will soon become available for analysis under GPES (General Practice Extraction Service).

This, plus data linkage to other areas of care (inpatient, outpatient, community), plus all the related data on patient-reported outcomes and clinical audit, means that this country may have the best data in the world on the use and costs and outcomes of care.

Now is the time to exploit this fact, but can we act fast enough?

It is unlikely that the Greenish White Paper due by June will solve the significant challenges of social care anytime soon. All eyes must be on the cross party talks on funding – whether there is the leadership needed to sort it is moot.

Meantime, our analysis is showing that those in care homes use less hospital care than those receiving intensive social care at home, or not receiving any local authority funded care at all. Much more digging is needed to unearth evidence about substitution of costs, as Wanless noted so many years ago.

In health though, our analysis over the last three years, so far shows little substitution of hospital costs by out-of-hospital interventions tried in England – see our summary of the latest results of an evaluation of the Department of Health-funded integrated care pilots.

My hunch: the interventions are not radical or sustained enough to slice through ingrained culture.

And the oomph question. People have grown grey discussing what motivates individuals in large organisations. The economists, sociologists, organisational psychologists, management theorists all have their own constructs with language to match.

My vote is for youth: get a bunch of young docs and managers circa age 30 in the room and the freshness/energy/bravery would be almost palpable.

In the 1940s the doers in the Ministry of War were mostly under 40. Let’s bypass some of the gerontocracy, because maybe the war is just starting.

Suggested citation

Dixon J (2012) ‘Where is the oomph?’. Nuffield Trust comment, 27 April 2012. https://www.nuffieldtrust.org.uk/news-item/where-is-the-oomph