Senior Officials

Foreword:

Niall Dickson

At the dawn of this new and fragile UK Parliament, the healthcare system is feeling uncertain and concerned. 
 
There is an unspoken plea to the political class to stop launching life rafts and to start fixing the ship. Yet there is little confidence this will happen any time soon. 
 
Everyone can see the Government’s vulnerability. The distraction of Brexit and the uncomfortable parliamentary arithmetic means not only that there will be no legislative reform, but that bold decisions and support for new models of care which upset local people, may be in short supply. 
 
The simple reality at the heart of much (not all) of this is that we simply do not have the resources to deliver what the public now expects. Of course there are efficiencies that could enable the NHS to do more within current resources (it is true that quality care is sometimes cheaper care) and those must be pursued with utmost vigour. But what is being expected over the next few years, particularly with a broken social care support system, does not seem doable within current budgets. In England, health spending per head has been flat since 2009 and has fallen slightly elsewhere in the UK, while demand has risen inexorably. 
 
It is therefore surely legitimate to ask what the right level of funding is and can we afford it? The Office for Budget Responsibility’s projection is that to meet rising demand, NHS spending in England could have to rise at around 4.5% a year in real terms. 
 
We urgently require an independent objective assessment of what the service needs in the short term and in the coming decade. The establishment of an Office for Budget Responsibility for Health could be the vehicle to deliver this. 
 
Alongside the money, the transformation agenda is equally daunting. In hard pressed health economies, genuine attempts to create services based on new models of care can be viewed as nothing more than cuts designed to save money. 
 
The Sustainability and Transformation Partnerships that are supposed to guide these changes have yet to prove themselves. Again they may well need political support for unpopular decisions that will ultimately benefit patients and communities. It would be great if politicians were genuinely willing to engage with the NHS, local government and local communities in helping to reshape local services.
 
Our call to action to politicians is therefore to be more willing to fund health and care, more supportive of radical change, more prepared to back services not buildings and more courageous in supporting new models of care that bring about better outcomes for patients. 
Niall Dickson
Chief Executive of the NHS Confederation