Over the last 10 years, investment in the NHS acute sector in England has seen fast growth, but the primary and community sectors have experienced none - even though they are producing better outcomes and patient satisfaction rates at reduced cost, MPs have been told.By investing in acute care but not primary and community care “we are backing the wrong horse,” Michael Sobanja, policy director of the NHS Alliance, has told the All-Party Parliamentary Group (APPG) on Primary Care and Public Health.
“The NHS cannot survive without significant change – there needs to be a much greater focus on the development of primary care and public health,” said Mr Sobanja, giving evidence to an inquiry, held by the APPG to look at whether the original 1948 vision of the NHS - of a health service available to all and financed entirely out of taxation - might now be under threat.
We need productivity rather than efficiency - the NHS cannot cope without service redesign. People are being treated more intensively in hospital, but we need to restructure services rather than pushing more people through hospitals, Mr Sobanja told the MPs.
“The early stages of the Quality, Innovation, Productivity and Prevention (QIPP) programme were about national initiatives, but QIPP 2 must be about service redesign and doing things differently,” he added.
The Group's co-chair, Nick de Bois, emphasised that the inquiry is looking at how to cut waste and help lessen demand on the NHS, to protect it and keep it safe for future generations, but it is not considering ways of funding other than through taxation. “I would hope that no parliamentarian would advocate a health service that is anything but free at the point of delivery or funded through taxation,” stressed Mr de Bois, who is Conservative MP for Enfield North.
In fact, the rapid growth in health spending in England has not been accompanied by an increased tax burden, Anita Charlesworth, chief economist at health policy think tank The Nuffield Trust, told the inquiry.
“Over the last 30 years, we’ve spent dramatically more on healthcare without the public feeling that they’re paying for it. There is not yet the perception that there is a problem. But we must use the NHS responsibly or we will lose it, and we must have this conversation with the public,” she said.
She also warned that the public are very concerned about the coming changes t the NHS. “They are being told that care needs to be moved more into the community but they wonder if the services will actually be there, so they need to be getting much more convincing evidence. We are putting so much effort into the closures but not into the new services,” she said.
Asked by the MPs what she believes to be the single most important thing that needs to be done in 2013-14 to help ensure a sustainable NHS for the future, Ms Charlesworth responded: “everything points to the centrality of primary care, but we have not seen any investment there. It is very difficult to explain why so many out-of-hospital services are run separately. We need a serious root-and-branch look at primary care as the hub of out-of-hospital care, and to revisit initiatives such as polyclinics.”
“And we won’t convince the population about the need for change without a proper conversation,” she added.
Michael Sobanja agreed. “The complexity of work undertaken by GPs has grown immensely in the last 10 years - many patients have long-term conditions and co-morbidities, and more people are now treated in primary care and community services. Yet there has been fast growth in the acute sector but none in primary care, which is producing better outcomes and patient satisfaction rates at decreased cost. We are backing the wrong horse,” he told the MPs.