A new report by the Health Foundation is calling for more support for providers of NHS care in England to ensure quality of care for patients does not deteriorate.
It is projected that by 2021 there will be a £30bn gap between the budget for the NHS in England and what it actually needs to deliver services. Until now, the financial squeeze has not impacted on overall quality of care for patients, as measured by national indicators. But with 60 Trusts now in the red, the Health Foundation says that ‘cracks are starting to appear’.
It states that quality of care is deteriorating in some key areas such as mental health, 18-week waiting times and cancer waits. Ignoring these challenges risks an avoidable crisis in the NHS in the months and years to come. To tackle these challenges, More than money: closing the NHS quality gap advocates that significant changes to services should be accelerated to improve and maintain quality.
It highlights the need for more coordinated care across different settings, more care provided outside of hospitals, and a greater role for patients through self-management and shared decision making. The complexity of these changes means they will take time and require sustained support – managerial, clinical, financial and political – across the NHS.
The report also argues that while extra money is needed for the NHS both in the short term (a transformation fund) and on an ongoing basis, money alone will not be enough to provide a comprehensive NHS that delivers care to existing levels of quality.
The report outlines three ways that this change can be supported within the NHS:
• Systematic improvement support for providers: The key organisations within the healthcare system should support providers of care in implementing improvements to services, both within their own organisation and working with other providers to deliver integrated care. Such support might include building skills in basic management, change management, improvement skills and analysis, all with the objective of improving quality and efficiency.
• Targeted resources: Two types of funding are needed: first a ‘transformation fund’ to allow new services to be introduced and existing services to be improved; and second, as the financial gap cannot be closed by productivity alone, ongoing additional funding.
• Political openness and support for change: Political support is critical for the changes needed both in the short and medium term. This should involve candid dialogue between politicians and both the public and NHS about the challenges, and why significant change is needed now.
Richard Taunt director of policy at the Health Foundation, and lead author of the report, said: “A debate is needed about how the NHS can best be supported to become more efficient and consistently provide high quality care. There is a risk that discussions around whether the NHS should be funded by the public or private purse become a dangerous distraction, at a time when the collective attention of the health service needs to be on how to deliver consistent and high quality care.”
