Reforming the English NHS

1. Reforming the English NHS Stephen P. Dunn, PhD, MA Senior Policy Advisor, Department of Health CMWF Harkness Fellow, 2003-4

2. The NHS today • treats 1 million people a day • spends over £5 million ($8.5m) an hour • polls show that 7/10 are happy with treatment • polls show that majority of the British public • are proud of the NHS • 4/5 think NHS is critical to British Society • must be maintained

3. = effective cost containment? Source: OECD (2002)

4. … but at what price? Five year cancer survival rates Source: Coleman (1999)

5. a legacy of under-funding! • history of under-investment • cumulative £220bn underspend compared to EU ave • too few doctors, nurses & other professionals • too many old, inappropriate buildings • late & slow adoption of medical technologies • gap between system performance & public expectation growing = make or break for NHS

6. = funding controversies Q1: how much should the country be spending? • publicly (and privately) on healthcare? A1: 9.4% Q2: what is the optimal speed of catch up? • given capacity constraints? A2: 5 years Q3: how should the extra revenue be raised? • what is the fairest and most efficient route?

7. A3: stick with taxation • ensure equitable, universal coverage • minimise risk selection, gaming & cost-shifting • harness monopsony power • minimise administrative costs

8. Investment • largest ever sustained increase in funding • 50% increase in NHS funding 2002-7 • reaching c£90bn (c$160bn) in 2007-08! • by 2008 total health spending will amount to 9.4% of national income • on a par with European levels

9. + Reform = • expanding capacity • establishing national systems • standards • audit • inspection • improving choice & responsiveness • diversity • contestability

10. + expanding capacity • growing the number of health professionals • 50,000 extra nurses, 5,000 more consultants & 1,500 GPs since 1997 • modernising infrastructure • 29 major new hospitals > 1,200 more general & acute beds in 2001/02 • 1200 GP premises refurbished or replaced • 200 new one stop-centres provided … major IT investment ...

11. modernising IT infrastructure • 3yr £2.3bn ($4bn) IT investment • country wide Electronic Health Record • Electronic prescribing and scheduling • aims • reduce medical errors, lost records, delays & duplication • efficiency & promote active case management • provide certainty of appointment times • underpin patient choice of providers

12. + expanding capacity • growing the number of health professionals • 50,000 extra nurses, 5,000 more consultants & 1,500 GPs since 1997 • modernising infrastructure • 29 major new hospitals > 1,200 more general & acute beds in 2001/02 • 1200 GP premises refurbished or replaced • 200 new one stop-centres provided • 3yr £2.3bn ($4bn) IT investment • supported learning and development • Modernisation Agency & NHSU

13. + national systems • national standards and targets • National Service Frameworks (NSFs) • National Institute for Clinical Effectiveness (NICE) • inspection and regulation • Health Commission • published performance information • Star ratings • direct intervention for failing providers

14. … and national targets, e.g. • cutting cancer death rates by 20% in people <75 by 2010 • cutting heart disease death rates by 40% in people <75 by 2010 • reducing death rates from suicide by 20% by 2010 • reducing inequalities in health by 10% by 2010 • measured by infant mortality & life expectancy at birth, • reducing the <18 conception rate by 50% by 2010 • guaranteeing access to primary care physicians to 2 days by 2004 • completing treatment (or admitting to hospital) all accident & emergency cases within four hours by 2004 • cutting the wait for NHS-funded surgery to 12 weeks by 2008 • improving patients’ experiences, as measured by national surveys • improving the value for money of NHS care by at least 2% per year

15. … and national targets, e.g. • cutting cancer death rates by 20% in people <75 by 2010 • cutting heart disease death rates by 40% in people <75 by 2010 • reducing death rates from suicide by 20% by 2010 • reducing inequalities in health by 10% by 2010 • measured by infant mortality & life expectancy at birth, • reducing the <18 conception rate by 50% by 2010 • guaranteeing access to primary care physicians to 2 days by 2004 • completing treatment (or admitting to hospital) all accident & emergency cases within four hours by 2004 • cutting the wait for NHS-funded surgery to 12 weeks by 2008 • improving patients’ experiences, as measured by national surveys • improving the value for money of NHS care by at least 2% per year • guaranteeing access to primary care physicians to 2 days by 2004 • completing treatment (or admitting to hospital) all accident & emergency cases within four hours by 2004 • cutting the wait for NHS-funded surgery to 12 weeks by 2008

16. + single payer, not single provider • active single payer, primary care led purchasing • introducing greater patient choice • aligning provider incentives • DRG type reforms • new primary care contract • new entrants & physician plural supply • international providers, e.g. United Kaiser? VHA? • devolving control = >choice, responsiveness, diversity & contestability

17. = major reform of the NHS redefining the model • a National Health System? = a national set of values = care free @ point of delivery based on need  monolithic provision • NHS as a national insurer • a mixed economy of provision • a Bismark / Beveridge hybrid

18. = new vision

19. = major risk ?!?!?! • the stakes are high • can the system deliver? • the next election is a key threshold • will enough have been achieved? … to earn Tony Blair another term? … and to give the NHS the time it needs?