2015 and beyond: time for bold thinking on the NHS

Ahead of next May’s general election, the future of the NHS will be one of the most important debates as the main parties outline differing views on what our health service should look like.

While it seems clear that reform is needed, politicians’ rhetoric can sometimes sound contradictory. Some, for example, are claiming that the Coalition’s current reforms are ‘the biggest shakeup’ in the history of the NHS, and yet the commissioner-provider-patient relationship still remains at the core of the operating model, ultimately overseen by civil servants. Others, meanwhile, are hailing the reforms as a logical step in maximising the quality of care, yet questions remain over whether they are genuinely improving the health outcomes of our population.

This leads us to the question: do we need to be evolutionary or revolutionary in reforming the NHS for 2015 and beyond? The 2012 Health and Social Care Act seems an evolutionary step in most senses, although its structural opening to new providers may be revolutionary to some; the devil will be in the detail, and in the oversight.

But where revolutionary thinking could and should be more universally supported is plotting a course to the NHS’ 75th birthday in 2023. By that stage, as our [email protected] report has shown, Bevan’s three core principles may be challenged by an overwhelming cost burden and a 21st century population with very different healthcare demands, activity norms and expectations to that of 1948.

In practice, this means that instead of focusing on reactive treatment, proactive prevention will be the ‘holy grail’ - and this will need to be delivered across an integrated system of health and social care provision.

This new, proactive approach will require policymakers and practitioners to focus on outcomes and not just activity, on innovative uses of data, and involve an element of risk sharing to maximise value for patients and the population. Equally important to this future approach is maintaining a regulatory structure that rewards good practice, while recognising that exits and failures are part of the cycle of service improvement. For politicians, however, provider failure can be a tough sell in a national debate that generates considerable emotion among the population.

The 2015 election will therefore offer us a glimpse of these realities. Certainly, there is agreement between the main parties that integrated care for patients should be at the heart of the health service.

How the parties differentiate themselves ahead of the general election, and whether they choose to debate the merits of prioritising outcomes or activities, could be decisive for voters. So too are debates around whole patient care and structuring new targeted, tailored patient pathways.

Addressing these issues is essential and the choice is stark. Should we adopt a more rationed yet universal service (to accommodate rising costs and an aging population)? Or create an NHS that fewer people need to use, because integrated community monitoring and education, delivered by a range of providers, becomes far better at preventing people from requiring care from the state in the first place?

Time for bold thinking, indeed.

Read more articles on