NHS chief executive Sir David Nicholson: ‘We know alter can be done. But it is difficult to imagine undertaking all these items with out some monetary flexibility.’ Photograph: David Levene
Billions of further funding will be necessary for the NHS to assist push via “unpleasant and unprecedented” modifications for the duration of the following parliament, the outgoing boss of the health support warns.
In a frank interview with the Guardian, Sir David Nicholson mentioned that whoever formed the next government would need to give the NHS extra funds simply because it could not survive if it had to continue to be in the straitjacket of austerity-era flat budgets following 2015.
The income would be necessary so the NHS can dramatically rationalise hospital providers, and concentrate its expert and GP solutions – enabling an NHS Nicholson calls “unsustainable” to ditch its outmoded reliance on hospital-based remedy and switch to a new model of neighborhood-primarily based care.
Nicholson declined to say how a lot far more cash he believed would be essential, but an additional senior NHS leader privately advised it could be up to £5bn additional a 12 months for several many years.
The NHS chief executive’s call for a “alter fund” on prime of the service’s present £110bn spending budget has sparked a renewed debate about no matter whether the NHS should continue to be a unique case for ministers confronting additional many years of tight public finances – and how much it wants to cope with the ongoing and long term rise in demand for healthcare.
Hospital services would also have to be centralised on a massive scale, he warned. GP surgeries essential to give up their part as the NHS’s equivalent of “corner stores” and a huge proportion of hospital care ought to be delivered in neighborhood settings if the NHS is to cope with the pressures posed by the ageing population, rise in the amount of sufferers with a single or much more lengthy-phrase conditions this kind of as asthma or diabetes, and demand for new remedies, Nicholson mentioned.
In long term there needed to be no more than 40-70 major centres of A&E care, even though the variety of organisations providing specialised services like cardiac care and transplantation had to shrink from 300 to just 15-30, he explained. He declined to put a figure on what would be the perfect quantity of GP surgeries in a streamlined organisation.
“We know this change can be completed,” he mentioned. “And we know that much more preventive operate in the local community minimizes demand on hospitals and that concentrating specialised solutions prospects to much better outcomes for sufferers.
“But it truly is challenging to envision doing all these issues without some monetary versatility to enable us to do that, some kind of modify fund that would enable us to do that”, explained the NHS boss, who leaves his publish at the end of the month soon after eight years to be replaced by Simon Stevens, former adviser to Tony Blair and Alan Milburn.
The further funds would enable the NHS to run existing hospitals although new solutions in the community had been created and created up with the intention of supplying a big sum of care.
It utilised a “adjust reserve” when it moved psychological well being care in the 1980s from standard asylums, which were closed, to new neighborhood-based providers – and that proved effective, he explained.
With out the NHS undertaking an overhaul in the way it delivered care it would encounter “managed decline above a period”, with fewer nurses on wards, rationing of medicines, longer waiting occasions for treatment method and a general decline in the good quality of care, he mentioned.
The alterations required had been important but are also “enormous, massive [and] unprecedented industry-broad change”, and would be “unpleasant for workers” and tough to persuade the public to accept. But failure to push them by means of could consequence in a decline in the high quality of NHS care – triggering a boom in personal healthcare and a collapse in public support for the support, he warned.
It is “unavoidable” that the next government would have to supply additional money to smooth that transition, he mentioned.
Paul Burstow, a Liberal Democrat health minister in the coalition right up until late 2012, explained that Nicholson’s message was “a reasonable evaluation of what’s essential to make change occur” but “will be unwelcomed by folks in all the events responsible for Treasury policies”.
Nicholson’s intervention comes as the tightness in the NHS’s finances will be illustrated when Danny Alexander, the chief secretary to the Treasury, announces on Thursday that all NHS staff will not be getting the 1% across the board spend rise from subsequent month promised final 12 months by the chancellor, George Osborne.
It is understood that the well being secretary, Jeremy Hunt, determined to block the award because he believed the NHS could not afford the expected £600m expense involved. Some workers are still expected to get an enhance.
Christine McAnea, head of overall health at the Unison trade union, stated: “If this rumour is true, NHS employees will be really angry. Their spend has fallen behind above the previous number of years and they deserve a respectable shell out improve and not to be treated with contempt by the coalition.
“I cannot feel that the government would be so foolish as to deny even a paltry one% to nurses, paramedics and therapists – it would be electoral suicide.”
Professor Chris Ham, chief executive of the King’s Fund overall health thinktank, also backed Nicholson.
“Our examination confirms that it is now inevitable that the following government will require to discover added funding for overall health and social care. The substitute is to accept important cuts to solutions that will harm care,” explained Ham, a former adviser to David Cameron on the NHS.