Indications that the government is edging towards a radical, long-term funding settlement for the NHS – as pressure grows from its backbenchers to get a grip on the problem – are raising hopes of a solution to the funding crisis. But more cash will force the health service to address even tougher questions than money.
With NHS trusts running an underlying deficit in the region of £3.7bn, there is a serious risk that the acute sector will rapidly soak up any new cash while primary, mental health and community services will again be left fighting over the scraps.
It would be folly to take even more taxpayers’ money – inevitably at the expense of other public services – without a concerted effort to drive out inefficiencies in the system, integrate more effectively, deliver on the numerous promises around prevention and early intervention and improve accountability to the public. A new funding settlement could prove the catalyst for yet another round of reforms. The trick will be to make them about patients rather than structures.
Many hospitals are beset with serious inefficiencies, from unacceptable variations in clinical performance – exposed by data from the Get It Right First Time drive – to wasting money on everything from pointless outpatient appointments to poor procurement of medical devices. Much of this information has been around for years. Hospitals are finally starting to get a grip on managing their estates long after local and central government took a robust approach to their property. Other parts of the NHS pay the price for this wastage.
Securing a new funding settlement would be a hollow victory if it simply reinforced the existing distribution of resources. First in the queue for new cash should be community-based services for physical and mental health, which would maximise the benefit to patients from the new investment.
The drive for integration is bringing further wastage in time and money as each local area tries to bend legislation designed for fragmentation and competition towards collaboration. This is spawning an ever more complex array of Heath Robinson legal structures, which even lawyers specialising in this field find tortuous and opaque. Entire senior management meetings can design and debate these arcane arrangements without once mentioning patients. Decisions are being driven by considerations such as VAT liabilities rather than how best to meet patient needs.
These structures are inefficient to construct and manage, seem irrelevant to clinicians, undermine accountability through their opacity and make the public (and growing numbers of Labour councillors) suspicious.
The astonishing amounts of time absorbed by structural issues prevent NHS leaders from focusing on the cultural and system changes among clinicians where the real integration of patient services happens and from where the best ideas will come.
This raises the spectre of another round of primary legislation – a horrifying thought. It is difficult to conceive of anything the prime minister would like less than to provide Labour with months of parliamentary time to attack the government over the health service. But the Conservatives could calculate that their decisive action on NHS pay, coupled with a new funding settlement and a bill to facilitate easier integration of services and improve public accountability, may deprive Labour of its key electoral advantage around the NHS.
It could even provide an opportunity to dispense with the purchaser/provider split, which the chief executive of NHS England, Simon Stephens, said last year would effectively be ended by local integration of NHS organisations.
Any legislation would need to avoid the pitfall of laying out a grand design for the whole country, instead allowing local areas to evolve their structures to meet local circumstances rather than to fit a central prescription.
With last year’s election gamble ending so badly, the odds must still be against a major NHS bill. The endless promises of action on social care funding complicate the decision further. But with or without legislation, any new financial settlement must be used to reshape the NHS, not perpetuate history.
Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views
If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs