Renew aims to enhance the life expectancy and health of UK citizens in the most fair, efficient and optimised way. We love the inspirational principles on which the NHS operates but wish to stabilise it. Over the coming years, research suggests that the NHS’s budget will need to rise just to maintain the current level of service. The majority of financial pressures arise from changes to population health, technology, pay and policy decisions. The number of people receiving treatment for chronic illness is increasing, attributable in part to the UK’s ageing population. However, the prevalence of other conditions such as COPD, lung cancer, and various cardiovascular illnesses is most heavily influenced by lifestyle factors such as smoking, alcohol misuse, obesity and lack of physical activity.
Our solutions are aimed at dealing with demand and the need for explicit choices about what is provided by the NHS, in mental health provisions and how we balance the needs of an ageing population and prioritise disease prevention. We must focus on reorganisation and better practices, making NHS bureaucracy more efficient and accountable. We must also accelerate work being done to deliver a genuinely integrated health and social care systems.
These problems are compounded by failures of the state elsewhere. A hospital is frequently the only state organ that cannot turn you away. When our community institutions fail, the NHS is often left to pick up the pieces. This is not just tragic for the people who suffer as a result, but is also far and away the most expensive way of dealing with these issues. For example, today one of the biggest challenges facing the NHS is access to social care, with frail patients stuck in hospital for want of a place elsewhere.
Though the Better Care Fund was an initial attempt to move towards integration, we now need nothing less than a fundamental reform of the funding of health and social care services and citizens’ entitlements to publicly funded support to address these problems. Successive governments have pretended there are easy answers to these challenges, whether through funding or massive reorganisations. They were wrong. Solving this problem to deliver a sustainable NHS free at the point of delivery will require a number of often painful choices, coupled with clear resolve.
Deliver improved services by:
- Amalgamating the NHS and social care, driving fundamental improvements. The problems facing the NHS relating to social care do not originate solely from inadequate funding, but also from the lack of alignment between the two services
- Placing staff at the forefront of developing the service, prioritising long term employment, allowing flexibility within contracts so that staff can improve productivity by looking after their wellbeing, and working to reduce the fiscal burden of contractors
- Revisiting management structures to help to streamline them
- Delivering funding increases in line or above current plans, creating additional tax revenue by legalising and regulating the sale of cannabis
- Unwinding PFI contracts, shifting the debt to central government, where it can be more cheaply funded
- Saving money through streamlining NHS procurement procedures in order to ensure maximum efficiency. Arguably, this could be done by a single, centralised body, possibly within the the Crown Commercial Service, with the responsibility of receiving and evaluating all initiatives submitted to it, regardless of origin or level of technology involved. It would then assess which should be applied regionally or nationally and in which sectors, and introduce a programme mandated to introduce some and strongly recommend others. A task force should also be created to support implementation in organisations that lack the capability.
- Rejecting Brexit and the impact it has had on our NHS in terms of people and procurement with rising import costs post-Brexit posing a significant threat to purchasing savings
- Explicitly asking the public to discuss the choices that will need to be made about the priorities of the NHS, given that it is impossible for the NHS to provide all services to all people
- Reviewing the disparity in funding between physical and mental health
- Seeking to centralise specialist services where this can improve patient outcome
Provide for a better quality of life by:
- Making assisted living programs more widely available through community care programs
- Reviewing funding models to eliminate the end-of-life lottery, where people suffering from some diseases must pay for large portions of their care, while others suffering from different diseases pay for none, possibly achieved through reforms to Inheritance Tax or funding models similar to those proposed by the Dilnot Commission
- Considering a means-tested Long Term Care system where adults over 65 are eligible for free personal care in their own homes, including personal hygiene, food preparation and mobility. If means testing was introduced simultaneously to winter fuel payments, this could yield enough to introduce free personal care
- Providing investments that might reduce costs in the future, i.e. by allowing hospitals to establish social and end-of-life care facilities to take pressure from hospital beds
- Solving the problem of bed blocking, particularly problematic for the elderly, for whom long hospital stays can be detrimental to health, increasing their long-term care requirements should begin with implementing more accurate data systems that take full account of the problem
Support new approaches by:
- Coordinating services to deal with particular areas of demand, alcohol abuse for example can be treated in specialist ‘Drink Tanks’, expanding Urgent Care Centres and GP surgeries in hospitals to reduce strain on emergency care and ambulance services
- Adopting a rational, science-led approach to drug policy and treating drug abuse as a health rather than a criminal issue, licensing the supply of the least harmful and generating revenue to be ploughed back into services, such as mental health
Harness the potential of data-led innovation by:
- Exploring the benefits of Precision Public Health, and innovative methodologies (smart monitoring) of detection. Careful analysis of treatment costs relative to the cost of prevention and the proportion of the population that develop certain conditions is necessary to determine the financial viability of prevention methods but could prove worthwhile
- Lowering running costs and improving efficiency by harnessing a wave of advanced medical technology and innovation. For example ‘telehealth’ allows both the remote monitoring of conditions such as diabetes and heart diseases and can be provided by devices in the home.
- Learning from the intersection between the NHS and community services. There are examples of high quality collaboration between social care, community services and hospitals where effective collection and analysis of relevant data has improved services and costs.
Prioritising prevention by:
- Investing a greater proportion of the NHS budget on preventative measures, rather than treatment, and precision medicine as a smarter way to approach a more sustainable health system
- Seeking to the long-term nature of the investment in public health which may have a profound effect if done efficiently, for example it is suggested that £1 investment in public health interventions is found to generate a £14 return
- Prioritising education around preventive healthcare programs for children, with health care packages monitoring physical development as well as psychosocial, speech development and emotional skills through regular help and support