What are the major currents shaping the future of healthcare in the UK?
As the next general election approaches, there is change on the horizon – but also reduced certainty and a lack of focus from politicians on detailed delivery over the next few months. Andy Kinnear, former NHS CIO and now Independent Consultant, looks at four major ‘ocean currents’ which are shaping UK healthcare whichever party comes to power and whoever becomes the next Secretary of State for Health and Social Care.
The state of the NHS is in the UK public’s top 3 issues
With the next general election set for 4 July, we are seeing politicians distracted by their own futures and campaigning, rather than detail and delivery within government departments. In particular the NHS finds itself in a state of limbo yet it will constantly be in the spotlight as politicians publish their manifestos, make health and social care commitments, and hit the campaign trail.
There are frequent polls as to what the voting public see as the key issues which will shape their voting plans. The Office for National Statistics (ONS) conducts a fortnightly survey on public opinions and social trends which asks GB adults about the important issues facing the UK today. The survey from the period 28 February to 10 March 2024, had the NHS at 83%, second only in the list of the most commonly reported issues to the cost of living at 87%. The economy was a distant third at 67%. A previous survey (11 to 22 January 2023) reported similar results with the cost of living at 93%, the NHS at 89% and the economy on 76%. So safe to say, with the NHS in the public’s top 3 issues, healthcare will be front and centre in the upcoming election campaign.
Focus on the underlying currents not just the crashing waves
In the healthcare sector it is easy to become focused on the next crashing wave which is about to hit you. This might be the latest strategic initiative coming from on high or an issue that could be in the headlines for a few days or weeks. In general election campaigns political ideologies drive policies and candidates react to what’s in the news. These things may be important but can distract from the underlying currents which are actually shaping the future of the NHS.
In my opinion there are four large ocean currents swirling round the NHS that are taking us in directions which cannot be ignored. These are:
- Massive workforce pressures
- Huge opportunities from new technologies
- A switch to a collaboration culture
- Inconsistency of funding
Workforce pressures cannot be ignored
The last two decades have seen unparalleled pressures on the NHS workforce. We’ve had nearly 20 years without a clear workforce strategy and plan. There’s been a decade of reduction in the real value of wages. The number of open job vacancies has increased and it seems that a vacancy level of 1 in 10 has somehow become the accepted norm. The staff have worked through a pandemic which has brought ‘hero status’ in the public’s eyes but left them fatigued and demoralised. There are continuing high levels of agency spend, with a Guardian article from January, 2024 headlined “NHS across UK spends a ‘staggering’ £10bn on temporary staff”. It’s pretty tough to be a frontline clinician right now.
Yet in a speech on March 7th just after Jeremy Hunt’s latest budget announcements, the current Health and Social Care Secretary said that “The productivity plan, along with the Long-Term Workforce Plan, will see productivity grow by 2 per cent per year. Meeting and exceeding the growth we saw in the last decade, and unlocking £35 billion of savings by the end of this decade.” The expectation of unparalleled efficiency gains leading to monetary savings seems to have been baked into financial plans stretching to the end of the 2020s. Ambitious to say the least.
To me it’s important that every initiative, strategy, plan and policy should be based firmly on how it will improve the lives of frontline clinicians day by day, not on theoretical efficiency savings. The focus of anyone in the digital health and care sector should be on how they can help the kindest people in our society. Nurses and doctors took the decision as teenagers to dedicate their lives to care for strangers. Strangers to them are family and friends to us. We must rededicate ourselves to support this workforce in all we do.
We’re entering the 4th industrial revolution
Some commentators are saying that we’re already beyond the Information Age including my good friend and health sector guru Russ Branzell, CEO, CHIME. We are already in the midst of the 4th industrial revolution – the Advanced Intelligence Age. Technology is advancing at an ever faster rate. This brings amazing opportunities but by and large leaders in the healthcare industry haves grown up and worked during the 3rd Industrial Revolution – The Information Age. A conceptual shift will bring new challenges for these leaders. How can we expect them to deliver the advantages the Advanced Intelligence Age brings if we do not support them in this endeavour.
AI and the further adoption of digital technologies will open up new possibilities but will change jobs, processes and interactions with patients. The current government is already counting on the digitisation of operating theatres to open up an extra 200,000 operating slots a year. Such changes will require innovators with clinical backgrounds and a focus on patients to harness real benefits. We need to be able to open the eyes of the workforce with ongoing education and trust them to identify and lead the innovations not impose theories.
From competition to collaboration
The NHS internal market was established by the National Health Service and Community Care Act 1990, to separate the roles of purchasers and providers within the NHS. For the last 3 decades this has resulted in a competitive culture with kudos being given to ‘winners’ - those driving hard on the latest initiative, or delivering against key targets. The space between Commissioner and Provider has too often been a battleground with the need to ‘win’ often trumping the need to serve.
The relatively new Integrated Care System (ICS) approach switches the focus from competition to collaboration and the integration of health and social care. It is a good thing, but such a major cultural shift will not just happen by itself. Post election, any additional ‘revolutionary’ rather than evolutionary changes, driven by ideology instead of a focus on our patients, our public and our care professionals, would introduce further turmoil to an already complex picture. I hope the culture of collaboration will be given time to flourish because it is not a 5-minute job.
Certainty of funding is needed
A long run up to a general election announcement and/or a protracted campaign will obviously create uncertainty in NHS funding. We’ve seen short termism already which makes planning and the delivery of the greatest benefits hard to achieve. This is especially true for digital initiatives where there has been inconsistency in funding and many silo’d programmes with single year funding which required major effort in securing and maintaining budgets for future years. The reality is that digital and AI solutions are here and now and need to be baked into day to day working and this can only happen with a long term funding plan.
In conclusion
General elections can defocus politicians from delivery. Ideologies and manifesto pledges can sometimes be at odds with what’s actually happening at the frontline and what’s really needed by staff and patients. Whatever waves break on the NHS in the coming months, the underlying ocean currents cannot be ignored. The fragilities and pressures in today’s NHS mean that we must focus on the fundamentals to turn the tide to support the workforce and deliver world class care to patients.