Filed Under (Health and Social Care Bill, Reform of the NHS) by Paul on 10-10-2011
This may seem obvious but it’s a point I want to underline. Every day, when working with the NHS, I am experiencing an odd dissonance between the internal changes that we are discussing (as if they are absolutely enormous) and the reality of the front page stories about the world economy – which are really absolutely enormous.
Before the meetings begin, over coffee and at the end people are reading the front and business pages of the papers with real anxiety about what the future will hold. Last Friday’s papers had the Governor of the Bank of England saying that the problems for the world economy are probably worse than during the 1930s.
When, during the course of my work with people in the NHS, we talk about these things there is a palpable anxiety about people’s household finances and their children’s living standards for the next year, the year after and in the future. Very very big things are happening and it’s difficult to see how over the next decade (and beyond) we can see our standard of living doing anything but falling (and perhaps sharply). It’s really scary and we are all trying to understand what will this mean for us – but whatever it means it will be disruptive.
Then we go into our work sessions on the NHS and plan for a future which will contain a very small growth in resources and an increasing growth in demand for health care. We struggle to rework of 4% of the budget every year and try and get that amount to move to primary settings from hospitals. It feels enormous and it looks as if this will create an NHS full of change for years to come.
Then we go back to the papers and the world economy and the apocalypse of change and disaster.
What I am trying to say is that I don’t think, when we think about the changes needed in the NHS, we fully understand the scale of what is going to be necessary. Today achieving 4% a year efficiency savings looks really tough. But if there is a ‘real world’ financial catastrophe the scale of this change will not be remotely big enough…
The speed of change; the agility of the NHS to push through much much greater innovation and efficiency will become a normal part of our day-to-day work. We will look back on what seemed to be the herculean task of achieving 4% efficiency savings for what it really is – small change in what is actually a historical period of massive change.
I don’t think I’m making this up. But what is curious is that the scale of change being predicted on the front pages of the newspapers is miraculously translated into much smaller changes by the time it gets to the page about the NHS.
Tomorrow the Health and Social Care Bill enters the House of Lords. (I will post about this tomorrow). The apocalyptic language used by its opponents is trying to make the point that the Government is proposing very large changes to the NHS.
As I will explain tomorrow the bill the government are taking to the Lords is a shambles. But if we talk about this shambles in apocalyptic terms what language are we going to use to talk about the nature and level of change that a reworked economic world order will leave us with?
If or when it comes, the financial apocalypse for this small island will come as a reality that will inevitably rush through the NHS changing the way in which we deliver its services. I believe if we can organise the necessary changes for the NHS with sufficient pace that we will be able to maintain the NHS’s founding principles.
That will be the real challenge of the next few years – not the reporting arrangements of GP-led clinical commissioners.