Keeping the NHS in public hands

A group of bodies including NHS England has put forward proposals to meet an expected £8bn funding gap for the NHS. Jeanette Whyman analyses the plans.

The publication of ‘NHS Five Year Forward View’ has clearly stated the choices to be made if the health service is to continue to be publicly funded. There is a yawning gap, to the tune of £30bn, between anticipated expenditure in 2020 and the funds available.

All the political parties are determined to polish their NHS supporting credentials prior to next year’s election and all have promised varying degrees of financial support – although all fall short of the actual figure required.

To address the projected £30bn shortfall, a consortium of six bodies, including NHS England led by chief executive, Simon Stevens, has proposed a number of changes calculated to save around £22bn – leaving just £8bn to be found (on top of any inflationary increases).

Streamlining hospital and community care

There appear to be two core objectives behind the proposals. First, that the impact of an ageing population on the health service must be reduced; and second, that people must be encouraged to pursue healthier lifestyles in order to stop falling ill in the first place.

The fact that the recipe for survival comes from the NHS itself, rather than the government, is seen by many commentators as a step in the right direction. The suggestion that lines between community and hospital care should be blurred – with GP practices housing hospital specialisms and hospitals housing GP services (put simply) – is designed to stop people being admitted to hospital in the first place. If the current rate of hospital admissions continues, something in the region of 22 extra hospitals will have to be built by 2020!

A patient-centric approach

These proposals dovetail with the emphasis on patient safety and putting the patient first. A more patient-centric approach with closer coordination between the health and social care systems is designed to have the effect of reducing hospital admissions. This in turn should reduce the number of negligence claims arising from inadequate care.

The question of who funds the care once a patient moves from the health system into the social system still needs answering – although Labour have indicated that they will pool the two budgets as recommended by the Barker Commission.

‘Physician heal thyself’

Nonetheless, a fundamental change in attitude among the general population will be needed if these proposals are to work. The idea of holding people responsible for illness resulting from ‘lifestyle’ choices and the withholding of certain types of treatment in favour of those whose conditions are not seen as ‘self-inflicted’ is potential political dynamite. This poses both a major ethical and a legal conundrum.

By the same token the recent announcement by the Government that GPs will be paid £55 for each patient diagnosed with dementia opens up another ethical, and potentially legal, dilemma. Should doctors be paid to diagnose a condition (isn’t that what they are supposed to do anyway)? What happens if the diagnosis is wrong? What is the point of diagnosis if there are limited resources to address the problem? That last point may be answered if the streamlining of hospital / community care happens and strategies are put in place to manage dementia cases effectively – and kindly.

Reducing the medical negligence bill

Those of us who have been dealing with the NHS for many years have seen initiatives come and go. But this particular one, driven by Simon Stevens, should ignite a public debate about what the NHS can, and cannot, realistically do. My main concern is that whatever reorganisation or reallocation of funds occurs, the principal actor in the show, namely the patient, is put firmly centre stage and resources are devoted to safe clinical practice and thoughtful patient care. Just halving the bill for medical negligence claims would start to make inroads into the £8bn shortfall.

Jeanette Whyman from Wright Hassall is a medical negligence solicitor with over 25 years’ experience and has acted both for and against hospital trusts. She now represents patients who are victims of medical negligence.