The Government must ‘stop approaching the NHS and social care as a liability to be managed, and instead look at it as investment that delivers a good return’.
However, ‘throwing money at the system’ will not on its own be sufficient if the UK’s health and care system is to be fit for the 21st century’. So says the Lord Darzi Review of Health and Care: Interim Report, a new report from independent ‘think tank’, the Institute for Public Policy Research (IPPR), which considers the current ‘state and condition’ of the NHS, highlights those areas where the greatest improvements have been made in the past decade, and looks at where – for example in efforts to ‘join up’ health and social care, provide early access for cancer treatment to all, and afford sufficient levels of support to the mentally unwell – substantial improvements still need to be made
April’s ‘Interim Report’ report was published almost 10 years after the Department of Health’s publication (in June 2008) of the influential High Quality Care for All, an initial report on the NHS and its future, compiled – as with the latest publication – by a team under the leadership of Lord Ara Darzi, a highly respected surgeon and former Under Secretary of State for Health. The ‘Interim’ Report is a follow-up and update to the earlier publication, whose findings were based on a comprehensive look at the strengths and weaknesses and future direction of the NHS led by Lord Darzi, well-known as a long-standing champion of a first-class, fit-fit-for purpose UK public health service. Commenting on the earlier report on its publication in 2008, the King’s Fund explained that it examined how the English NHS could ‘move on from a centrally driven performance management regime – with its focus on driving activity and meeting targets – to a more sophisticated strategy’.
This year’s Lord Darzi Review of Health and Care: Interim Report was unveiled in April, in the NHS’s 70th anniversary year, at what the authors argue is an apposite time to focus on the NHS’s future direction and strategy. It was published a few months in advance of a ‘Final’ report, expected to be unveiled later this year, which the IPPR promises will ‘set out a long-term funding and reform plan or health and care’.
The Report’s summary says the ‘picture on population on health’ over the past decade has been ‘mixed’, with ‘important progress made on some metrics’ – such as continuing reductions in rates of smoking and alcohol consumption, contrasting with ‘some substantial challenges’. These include the fact that while life expectancy has been growing, this has been ‘at a slower rate than the historical norm’. Moreover, the Report concludes that overall quality of life across a number of metrics has ‘faltered’.
Among other ‘negatives’ have been a continued rise in mental health conditions, not matched by sufficient spending to address the issue – despite repeated Government pledges to achieve parity between physical and mental health, and the re-emergence of growth in social inequalities.
More positively, the Report notes that ‘despite a decade of austerity’, quality across most areas of the service – from cancer to trauma and stroke to diabetes, has been ‘maintained or improved’. Patient safety has also ‘got better, according to most metrics’.
Lord Darzi and the other contributors caution, however, against complacency, warning that ‘there remains far too much variation in the quality of care’, and that ‘the distance between the best and the worst’ remains ‘too wide’. The Summary says: ‘In too many areas – and cancer and mental health services particularly – progress has been from a low base, with other countries performing significantly better’. The Summary also notes that, with tight fiscal constraints over the past decade – a ‘period of austerity for the NHS’ – ‘there is increasing evidence that we are reaching a tipping point, with the drivers of improvements coming up short given the pressures on the system’.
One of the major areas of concern, particularly given the past 5-10 years’ focus on improving the links between health and social care to improve the patient pathway, has been ‘a serious decline’ in the number of people receiving state-funded social care. The Report says this has ‘pushed more and more responsibility onto informal carers, and left many without the support they need’. It adds: ‘The stress on the whole system – primary and community services, acute care, and social care – is vividly illustrated by the significant increase in delayed transfers of care over the period’. Also noted are ‘signs of rationing in terms of access to new and innovative treatments, as NHS patients are denied care that is at the scientific and technological frontier’.
One of the more alarming financial conclusions is that, based on the authors’ modelling, by 2030 demand pressures – ‘without changes to the way the NHS works’ – will rise to £200 bn in today’s prices, with pressures on the social care system expected ‘if anything’ , to be even greater. The authors say that, ‘even if we are to put the NHS back on its long-run funding trajectory and fill the social care funding gap’ – which the report says will require an extra £50 bn on the NHS and £10 bn on social care in tax contributions annually by 2030 – ‘we would still need radical reform in the way the system works to drive productivity in the NHS up to 1.1 per cent per annum, around one and a half times its long-run trend of 0.8 per cent’.
In its ‘Conclusions’, the publication argues that that while the health and care system have ‘done exceedingly well to maintain or increase quality in the context of austerity, we must now build on this success by reinvesting in quality as the organising principle of the NHS and social care system’.
Arguing that the health and care system has ‘reached a tipping point’ the Report says the main sources of increased productivity are ‘running out of road’, while the system’s ability to find other sources of revenue funding – be it switching capital to revenue (which has impacted on funding to improve and upgrade the estate), ‘dipping into reserves’, or growing deficits, is ‘increasingly limited’,
Having ‘demonstrated’ that the health and care system will need up to an additional £60 bn per annum by 2030, the report acknowledges that ‘money alone will not be enough’.
While acknowledging that the ‘traumatic nature, both in concept and execution’, of the substantial reforms and reorganisation of UK healthcare following the publication of the 2012 Health and Social Care Act ‘induced a collective state of post-traumatic stress disorder’, the Report contends that ‘now is the time for a bold reform plan if our health and care system is to be fit for the 21st century’. It adds: “The term ‘reform’ has become a trigger-word for the NHS that understandably provokes alarm and distress, yet the current situation is simply not sustainable. And so it is time to say what must be said: reform needs to be back on the table. The gift that the NHS needs on its 70th birthday is a pragmatic plan to secure it for for future generations.”
The full report, Lord Darzi Review of Health and Care: Interim Report, is downloadable at https://tinyurl.com/y7f6jdsb
