The Chancellor Alistair Darling has announced that spending on the National Health Service will climb 4% a year in real terms to hit £110 billion in 2010.
The rise overshot general expectations, but still marks a step down from the 7% year-on-year growth seen since 2002.
According to the 2007 Comprehensive Spending Review, this investment, plus additional ‘money for value’ savings of at least £8.2 billion, will help the government deliver a health service that is “fair, personalised, effective, safe and locally accountable.”
Central to this aim is improving access to GPs, for which the government has promised additional resources for practices in the bottom quartile in terms of provision, as well as for 150 new health centres that are to open their doors seven days a week.
In addition, the funding should help to get hospitals cleaner, with MRSA screening for all elective patients next year and the ‘deep-cleaning’ of hospitals to return them to their original state, as well as foster more innovation in the NHS, with the establishment of a new Health Innovation Council and implementation of recommendations made in the Cooksey Review.
Freeing up resources
The goverment hopes that its commitment to continue increasing funds NHS will be met by a drive to garner savings to the tune of at least £8.2 billion. This, it says, will ultimately stem from decisions based at the local level, but it suggests three general areas where substantial savings by primary care trusts could be made:
– Changing the way health services are delivered, such as improving community-based services to help cut back on expensive emergency admissions, could potentially free up £500 million each year by 2010-11;
– Reducing fluctuations in productivity by spreading new technologies and best practice across the Service, to garner savings of £1.5 billion per year by 2010-11; and
– Better procurement practices to save £1 billion by 2011.
Reaction to the spending review has been largely positive, although
there is a definite undercurrent of concern that the boost in funds is being directly linked to significant productivity gains, which some argue is not entirely realistic.
Andy Cowper, Editor of the British Journal of Healthcare Management told PharmaTimes: “The 7% growth year-on-year since 2002 has delivered some real improvements: look at waiting times, which are on course to have dropped to 18 weeks from GP referral to treatment by 2008.”
“However,” he stressed, “the next stage of NHS reform is about developing new, better, more efficient and more responsive services – not about buying more of the same. What’s needed now isn’t about spending more – it’s about spending more effectively.”
The NHS Alliance, an independent body representing primary care, commented: “It is a major mistake to confuse productivity in the health service with simple unit costs. The price of a particular operation or a GP consultation tells us next to nothing about real NHS productivity. Current techniques for measuring it fail to examine much of what the NHS does and should do. New methods are needed.”
And its chairman Dr Michael Dixon, added: “We need a far more
sophisticated idea of what productivity is in the health service. So much of what we are now achieving does not figure in the accountants’ balance sheets. But it should.”
Clinical redesign
But the NHS Confederation maintains that, “although there has been a tendency to criticise the NHS on value for money, recent reviews have suggested that the service has in fact made significant productivity gains, due to increases in the quality of care.”
It says that further improvements in productivity can only be achieved with “a serious redesign of clinical processes,” which must be led locally and will “take time to deliver sustainable results”.
On a different tack, Hamish Meldrum, Chief Executive Officer of the British Medical Association, noted that the strengthening financial position of the NHS, with many trusts predicting a financial surplus for this year, should help monies to be directed towards improving patient services rather paying off debts.
But he warned against increasing ties with the private sector to boost NHS capacity, as it being planned in many aspects of care. “It would be a grave mistake if NHS resources were again squandered on costly and poor value private sector deals where profits are often rated higher than patients. Excessive use of the private sector in providing NHS care will fragment care for patients, could threaten the existence of many district general hospitals and risks destroying the proven and trusted model of UK general practice.”
And he also ephasised the need for a greater focus on getting the public to improve their own health to ensure the most value out of NHS resources is obtained.
