What are the
prospects for the
NHS in the new
Parliament?
Professor Chris Ham
Chief Executive
7 July 2015
2010-15
› NHS spending grew in cash and real terms, but
much more slowly than historical trends
› Adult social care spending was cut with c.25%
fewer people receiving publicly funded care
› NHS largely coped until 2014 when deficits
emerged; in 2014/15 aggregate provider
deficits were c.£800 million
› Forecast NHS provider deficits in 2015/16 are
up to £2bn
2015-20
› NHS budget will increase by ‘at least’ £8bn by
2020/21
› ADASS estimates adult social care faces a
funding gap of £4bn by 2020/21
› NHS needs to deliver £22bn productivity
improvements to bridge its funding gap of
£30bn
› This has never been achieved before
Three big challenges
› Sustaining existing services and standards of
care
› Developing new and better models of care
› Doing both of the above by engaging staff and
reforming ‘from within’
Sustaining existing services
› Keeping the focus on quality of care and patient
safety
› Maintaining good performance on key targets
like waiting times
› Recruiting and retaining (and training) the
workforce of the future
› Balancing budgets
Developing new models of care
› Implementing the five year forward view and
integrating care
› Developing out of hospital care through GP led
family care networks
› Giving priority to prevention and population
health improvement
› Taking forward Devo Manc and extending to
other city regions over time
› Embracing new technologies where they bring
benefits
The focus of population health systems
Reforming the NHS from within
Successive governments have relied on external
pressures to reform and improve the NHS
Much more emphasis should be placed on change
being led locally
High performing health care organisations and
systems around the world show how this can be
done
Devolution and transparency should have greater
priority
What does this mean for the NHS?
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Organisational stability
Leadership continuity
Vision focused on quality and safety
Specific goals for improvement
Systematic measurement of progress towards
goals – plus public reporting
› Development of leadership at all levels
› Training in QI skills and methods
What does this mean for the NHS (2)?
› Understanding and responding to what matters to
patients
› Seeking and acting on patient feedback
› Leaders who listen to and engage staff
› Leaders who create time for staff to care and
remove obstacles to safe and high quality care
› Leaders who are personally and visibly committed
to patient-centred care
Leadership is needed at all levels
The leadership challenge
CEOs and senior colleagues have to make a
sustained commitment to reform from within
It requires leaders of NHS organisations to be
personally and deeply involved
These leaders must be willing to themselves
devolve power
Meaningful staff engagement and clinical
leadership (esp. medical) are essential
Partnership between experienced managers and
skilled clinical leaders is critical
Clinical leadership
High performing systems have many impressive
clinical leaders
They have invested in developing these leaders
who are bilingual
Clinical leaders know that delivering better
outcomes reduces waste and inefficiency
Our new report out today argues that this is
where the NHS must focus to deliver £22bn
The holy grail is better outcomes at lower cost
through changes to clinical practice
A long march
› Real and sustainable improvement takes time
› It occurs through ‘the aggregation of marginal
gains’ not big leaps forward
› Improvement must draw on the intrinsic
motivation of doctors and others to provide high
quality care and peer review
› Political leaders should set budget and system
objectives but not micro manage
› Regulation needs to be proportionate and give
NHS organisations space in which to improve
care
Devolution and transparency
The NHS is arguably the most centralised health
care system in the world
Devolution linked to transparent reporting of
performance data should have greater priority
Devo Manc is one way of making this a reality
Earned autonomy and proportionate regulation
are also needed
The NHS is too big and complex to be run from
Whitehall
Systems of care
The NHS in England is too fragmented – local
systems of care must evolve
Systems of care need to link hospitals,
community services and primary care e.g. in a
city or county
Systems don’t mean mergers: they are alliances
and networks of providers and commissioners
Systems offer the best hope of the NHS
sustaining services and developing new care
models
What do systems require?
Sophisticated governance arrangements with real
teeth
Risk sharing agreements developed ex ante
Support from national bodies to facilitate and
remove obstacles
Leadership by experienced teams with a track
record of success
Finally: the immediate prospects
The new government has sought to regain control
of NHS finances
Expect this to be a dominant theme with NHS
providers challenged to balance budgets
The drive on the Carter review on efficiency will
be pushed much harder
Staffing levels and costs will come under
pressure
Can this be done without compromising safety
and quality of care?
Thank you
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