Sustaining the Vision

The quest for an NHS that delivers top quality services at a cost-effective price is the focus of a new policy/discussion document just published by the NHS Alliance. Called Sustaining the Vision: how the NHS can survive the looming financial crisis, the report debates how world class services can be achieved at a time when the NHS must cope with limited, zero or even negative economic growth.

The report puts forward 10 recommendations in a bid to jump-start discussion and debate within the NHS, amongst policymakers and politicians of all parties, as well as with the public.

Launching the report at the NHS Alliance annual conference in Manchester, Dr Michael Dixon, chairman, NHS Alliance, said: “If the NHS is to survive, people need to see it as a mutual scheme, with local membership, engagement and accountability. Leading from the centre is not an option. Local primary care services are the answer to a more cost-effective and efficient health care which reflects local needs and delivers holistic care.”

NHS funding will fall short of the population’s health needs by between 6 percent and 32 percent by 2016-2017.  Dr Dixon said, “In terms of services, the current mindset, which prioritises national targets and creates a disconnection between primary and secondary care, means that the health inequalities gap is likely to grow even deeper and improvements seen in the quality of services could well become either unaffordable or unsustainable.”

Key recommendations for discussion and debate are:

• We must refresh and renew the compact between the NHS and citizen, so that the service is positioned as a mutual insurance scheme, where people can see what they contribute and how much healthcare resource they use, and be engaged in the debate about what the NHS can afford.
  
  
• We must make the NHS local, with local membership and accountability to reinforce public engagement and ownership. We should all be default members of the NHS through our local PCT.
  
  
•  We need to bring specialist services out of hospitals into the community. Those specialties that have a responsibility to the wider population beyond hospital inpatients should be located in the community, where their expertise can be used to help prevent disease and plan services for all, not just those who are most acutely ill.
  
  
•  Create a bonfire of the quangos – hold a review into the roles and purpose of arms length bodies and abolish those that are unnecessary or duplicate other functions, such as Monitor. This would save money and avoid distracting front line staff from their core role of patient care.
  
  

• Integrate community services with primary care, rather than create yet another set of new organisations for patients to navigate. This would help to ensure services reflect local needs and deliver care to the whole person.
  
  
• Enable PCTs to set cash limited budgets with all providers, including Foundation Trusts. Otherwise they are at the mercy of the piece rate tariff of Payment by Results, which encourages trusts to increase their activity.
  
  
• Make the Payment by Results tariff the ceiling price, not the floor, giving providers an incentive to reduce costs.
  
  
• Task the choice and competition panel with putting the public interest first, before the need to create a market for care.
  
  
• Encourage co-operation between health providers and commissioners where it is clearly in the public interest and saves time and money – particularly in the provision of and redesign of essential core services to local populations.
  
  
• Create clinical leadership that includes primary care at every level of the NHS, from Practice Based Commissioning groups and PCTs to Strategic Health Authorities and the Department of Health, with clear lines of communication from the very top to the frontline.