The National Health Service

How do we build and develop a sustainable NHS service?

Depending on which current political party you subscribe to, the NHS is the “crisis of our time”, or the approach should be a “person-centred approach to health care”, or the privatisation of the NHS is the major upheaval of our age.

So the question is: how do we think about the provision of health care differently? What are we not seeing right now that is really important to the NHS?

National Health Service Funding

Money is not the answer. Increasing complex thinking at the top of the organisation is key to improving not only the service delivery, but also the innovation in the service going forward. Why are we asking questions about the perpetual influx of cash to help the decision-makers make better decisions, yet we are not looking at the capacity and capability of said decision makers to make those decisions in the first instance?

For example: politicians generally have a four year term, therefore their decisions rarely go beyond the length of their term. Then we have to factor in the potential for them making two year decisions as they invariably spend the second half of their term trying to stay in power. Plus, they see the futility of making long term decisions in their service when their decisions are only going to be overturned by the next government should the political stage change.

This needs to be combated by ring-fencing money for the NHS that is cross-party, beyond politics, and which allows decisions to be made for at least ten years to ensure the long term health of the organisation.

More importantly, the decision-makers need to be capable of making long term decisions, having experience in managing large organisations in their past. The problems arise within Trusts when people who are excellent carers are promoted to be decision-makers of what is, essentially a very large organisation – business – but isn’t treated or thought of as such by those health care professionals promoted from within.

Another thought to consider is the procurement aspect of the NHS. As individuals Trusts, the procurement of drugs for patients, cleaning materials for facilities departments and even cooking utensils for the kitchens, it could be argued, should all be centralised to ensure the best possible price for all suppliers, who also have to put caveats in place in order to ensure they continue to provide should their business fold within the timeframe of their contract. If a drug supplier has a ten year, £100MM contract to supply a central NHS purchasing department, it would be required to place £50MM into a fund so that if their business fails, the NHS has a buffer as a fail-safe.

These are all ideas that would alleviate the strain on the current NHS: long term thinking: stop suppliers from charging £8 for a 32p tablet; mitigate the political zeitgeist by removing the politicisation of the NHS, and so on.

Here are some statistics that offer some idea of how we, as the Non-Partisan Party have come to some of our decisions on the NHS. As you would expect from us, any decisions we would make on the NHS would be transparent and open to discussion by you, the voting public.

Thinking Differently About Funding

Mutual Health Service. Localised mutual payment.

The point being made here is that the centralisation of funding causes more problems than it resolves.

Why would it be better to fund the NHS in this manner?

Here is some information on the most recent costs of the NHS, updated in July 2015:

  • NHS net expenditure (resource plus capital, minus depreciation) has increased from £64.173 billion in 2003/04 to £113.300bn in 2014/15. Planned expenditure for 2015/16 is £116.574bn.
  • Health expenditure (medical services, health research, central and other health services) per capita in England has risen from £1,841 in 2009/10 to £1,994 in 2013/14.
  • The NHS net deficit for the 2014/15 financial year was £671 million (£151m underspend by commissioners and a £822m deficit for trusts and foundation trusts).
  • The most recently published national surveys of investment for mental health found there had been real terms reductions of 1 per cent for working age adults and 3.1 per cent for older people in 2011/12.

Providers and commissioners of NHS services

There are currently in England:

  • 209 clinical commissioning groups (including 199 now authorised without conditions)
  • 155 acute trusts (including 100 foundation trusts)
  • 56 mental health trusts (including 43 foundation trusts)
  • 34 community providers (15 NHS trusts, 3 foundation trusts and 16 social enterprises)
  • 10 ambulance trusts (including 5 foundation trusts)
  • c.8,000 GP practices
  • 853 for-profit and not-for-profit independent sector organisations, providing care to NHS patients from 7,331 locations

NHS staff

  • In 2014 the NHS employed 150,273 doctors, 377,191 qualified nursing staff, 155,960 qualified scientific, therapeutic and technical staff and 37,078 managers.
  • There were 32,467 additional doctors employed in the NHS in 2014 compared to 2004. The number has increased by an annual average of 2.5 per cent over that time.
  • There were 18,432 more NHS nurses in 2014 compared to ten years earlier. The number has increased by an annual average of 0.5 per cent over that period.
  • There were 5,729 more GPs and 1,688 more practice nurses employed by GPs in 2014 than ten years earlier.
  • There were 12,432 more qualified allied health professionals in 2014 compared to 2004. However the number of qualified healthcare scientists has declined for each of the past five years, with the number in 2014 874 below that of 2004.
  • 50.6 per cent of NHS employees are professionally qualified clinical staff. A further 26.0 per cent provide support to clinical staff in roles such as nursing assistant practitioners, nursing assistant/auxiliaries and healthcare assistants.
  • An NHS Partners Network survey shows that more than 69,000 individuals are involved in providing front-line services to NHS patients among their membership. Approximately two-thirds are clinicians.
  • Since 2004 the number of professionally qualified clinical staff within the NHS has risen by 12.7 per cent. This rise includes an increase in doctors of 27.6 per cent; a rise in the number of nurses of 5.1 per cent; and 8.1 per cent more qualified ambulance staff.
  • Medical school intake rose from 3,749 in 1997/98 to 6,262 in 2012/13 – a rise of 67.0 per cent.
  • Management
  • Managers and senior managers accounted for 2.67 per cent of the 1.388 million staff employed by the NHS in 2014.
  • The number of managers and senior managers increased slightly in 2014, having declined in each of the previous four years. However 37,078 was the second lowest total since 2004.
  • In 2008/09 the management costs of the NHS had fallen from 5.0 per cent in 1997/98 to 3.0 per cent.

International comparisons

  • In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2014.
  • The NHS was rated as the best system in terms of efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.
  • However in the category of healthy lives (10th), the NHS fared less well.
  • Current health expenditure in the UK was 8.46 per cent of GDP in 2013. This compares to 16.43 per cent in the USA, 11.12 per cent in the Netherlands, 10.98 per cent in Germany, 10.95 per cent in France, 10.40 per cent in Denmark, 10.16 per cent in Canada and 8.77 per cent in Italy.
  • Current expenditure per capita (using the purchasing power parity) for the UK was $3,235 in 2013. This can be compared to $8,713 in the USA, $5,131 in the Netherlands, $4,819 in Germany, $4,553 in Denmark, $4,351 in Canada, $4,124 in France and $3,077 in Italy.
  • The UK had 2.8 physicians per 1,000 people in 2013, compared to 4.1 in Germany, 3.9 in Italy, 3.8 in Spain, 3.4 in Australia, 3.3 in France, 2.8 in New Zealand and 2.6 in Canada.
  • The UK had 2.8 hospital beds per 1,000 people in 2013, compared to 8.3 in Germany, 6.3 in France, 3.1 in Denmark, 3.0 in Spain and 2.8 in New Zealand.
  • Average length of stay for all causes in the UK was 7.0 days in 2013. This compares to 17.2 in Japan, 9.1 in Germany, 7.7 in Italy, 7.6 in New Zealand, 6.6 in Spain and 5.6 in France.

Patient experience

  • In the 2014 Care Quality Commission inpatient satisfaction survey 84 per cent of c56,300 respondents rated their overall experience as 7 (11 per cent), 8 (24 per cent), 9 (22 per cent) or 10 (27 per cent) out of 10.
  • 81 per cent felt that they were always treated with dignity and respect while using inpatient services.
  • 69 per cent said that their room or ward was ‘very clean.’
  • In the 2011 Care Quality Commission outpatient survey 95 per cent of people using outpatient services reported their care as being excellent (44 per cent), very good (39 per cent) or good (12 per cent).
  • 89 per cent of people agreed that they were treated with dignity and respect at all these times while visiting outpatient services.
  • 67 per cent of respondents to the CQC’s community mental health services survey for 2013 rated their experience between 7 and 10 out of 10.
  • 78 per cent ‘definitely’ felt listened to carefully and 72 per cent ‘definitely’ had their views taken into account.
  • In May 2015 95.37 per cent of 184,711 inpatients treated by NHS trusts and foundation trusts would recommend their provider to friends or family (25.9 per cent response rate). For 16,243 inpatients treated by independent sector organisations, the proportion was 99.0 per cent (43.4 per cent response rate).
  • Aggregated GP Patient Survey results from July-September 2014 and January-March 2015 found that 84.8 per cent of respondents rated their overall experience at the GP surgery as ‘very good’ or ‘fairly good.’
  • 63.5 per cent ‘definitely’ had confidence and trust in the last GP they saw. 74.9 per cent were satisfied with the opening hours of their practice.
  • 68.6 per cent stated their overall experience of out-of-hours GP services was ‘very good’ or ‘fairly good.’

NHS activity

  • The NHS deals with over 1 million patients every 36 hours.
  • In 2013/14 there were 44 per cent more operations (‘procedures and interventions’ as defined by Hospital Episode Statistics, excluding diagnostic testing) completed by the NHS compared to 2003/04, with an increase from 6.712m to 9.672m.
  • The total annual attendances at Accident & Emergency departments was 22.364m in 2014/15, 25 per cent higher than a decade earlier (17.837m).
  • The 95 per cent standard to see patients within 4 hours of arrival at Accident & Emergency departments was achieved in 21 weeks during 2014.
  • There were 15.462m total hospital admissions in 2013/14, 32 per cent more than a decade earlier (11.699m).
  • The total number of outpatient attendances in 2013/14 was 82.060m, an increase of 8.8 per cent on the previous year (75.456m).
  • In the year to September 2014, 418,661 NHS patients chose independent providers for their elective inpatient care. There were 688,977 referrals made by GPs to independent providers for outpatient care during the same period.
  • There were 1.747m people in contact with specialist mental health services in 2013/14. 105,270 (6.0 per cent) spent time in hospital.
  • There were 21.706m outpatient and community contacts arranged for mental health service users in 2013/14.
  • 53,176 people were detained for more than 72 hours under the Mental Health Act in 2013/14.
  • There were 3.140m category A calls (Red 1 and Red 2) that resulted in an emergency response in 2014/15, 9.3 per cent more than the previous year (2.872m).
  • 71.9 per cent of Red 1 ambulance calls were responded to within eight minutes in 2014/15.
  • There was an 18.5 per cent increase in emergency incidents between 2007/08 and 2012/13, reaching 6.89m in the latter year.
  • At the end of April 2015, there were 3.026 million patients on the waiting list for treatment. 202,590 (6.7 per cent) had been waiting for longer than 18 weeks, compared to 188,774 (6.3 per cent) at the same point in 2014.
  • Over the past three years the number of patients waiting longer than a year for treatment has declined from 4,213 in April 2012 to 411 in April 2015. In the same period, the number waiting in excess of 26 weeks has increased from 54,219 to 63,285.
  • 87.5 per cent of people with admitted pathways (adjusted) were treated within 18 weeks of referral in April 2015, compared to 90.0 per cent a year earlier.
  • 95.2 per cent of people with non-admitted pathways were treated or discharged within 18 weeks of referral in April 2015, compared to 96.3 per cent a year earlier.
  • At the end of April 2015, 834,067 patients were on the waiting list for a diagnostic test. Of these, 2.0 per cent had been waiting in excess of six weeks.

Health and population

  • Life expectancy for UK men in 2011-13: 78.9 years.
  • Life expectancy for UK women in 2011-13: 82.7 years
  • The UK population is projected to increase from an estimated 63.7 million in mid-2012 to 67.13 million by 2020 and 71.04 million by 2030.
  • The UK population is expected to continue ageing, with the average age rising from 39.7 in 2012 to 42.8 by 2037.
  • The number of people aged 65 and over is projected to increase from 10.84m in 2012 to 17.79m by 2037. As part of this growth, the number of over-85s is estimated to more than double from 1.44 million in 2012 to 3.64 million by 2037.
  • The number of people of State Pension Age (SPA) in the UK exceeded the number of children for the first time in 2007 and by 2012 the disparity had reached 0.5 million. However the ONS currently projects that this situation will have reversed by 2018, with 0.3 million more children than those at SPA.
  • There are an estimated 3.2 million people with diabetes in the UK (2013). This is predicted to reach 4 million by 2025.
  • In England the proportion of men classified as obese increased from 13.2 per cent in 1993 to 26.0 per cent in 2013 (peak of 26.2 in 2010), and from 16.4 per cent to 23.8 per cent for women over the same timescale (peak of 26.1 in 2010).

Private Enterprise

So how do we help fund the above without burdening the tax payer even more? By making some concessions, it is entirely possible that the NHS could be sustainable in the long run by employing private enterprise to relieve some of the stresses on the offering, whether that’s at the forefront of the Service in A&E, or in the background with administration staff.

The difference in the NPP approach is for any organisation that is contracted to provide a service to the the NHS, a certain percentage of their profits are to be ploughed back in to the NHS in order to fund it going forward.
This relieves the burden on the government and the taxpayer and ensures the long term future of the NHS for the citizens of the UK.

Community Care

There is no logical reason why should we use the existing strategy for community care when we are aware of other methods in Europe that far exceed our own abilities. The sensible thing to do would be to adopt a more robust and profitable system for community care, by engaging with experts in Belgium and Holland to emulate the thinking behind their system of care delivery.

Could you get behind this as a policy that transcends all partisan ideals?

Information taken from: