NHS services in the face of increasing demand what does it mean for - - PowerPoint PPT Presentation

Monday 11 September 2017 Royal Institution of Chartered Surveyors

NHS services in the face of increasing demand – what does it mean for patients?

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The NHS in 2017

Richard Murray Director of Policy, The King’s Fund

The NHS in 2017

› The core challenge › More for less (or lots more for slightly more) › Bringing it all together

The core challenge

90 100 110 120 130 140 150 160 170 180

Index value (2003/4=100)

Department of Health real terms funding and total hospital admissions, 2003/04 = 100 Funding Admissions

Funding: 2015/16 prices as at Dec 2016; Admissions, actual to 2015/16, NHS England `unmitigated demand’ for acute services after 2015/16

• Sustained (relative)

austerity in the NHS budget has not been matched by changes in activity

• Recent NHS productivity

compares well to whole- economy activity

• The NHS (rather than

health) looks relatively cheap by international standards

And its getting harder, not easier

0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5%

Annual real terms growth in health spending, 2010/11 to 2020/21, %

• Some of the

growth in recent years was not part

• f the original plan
• The Budget may

give some relief (though possibly not much)

What does this mean?

• 2.00%
• 1.00%

0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Annual percentage increase in FTE qualified nursing, midwifery & health visiting staff

• A truism that healthcare

is a service industry and workforce accounts for the majority of spending

• Though not one-to-one,

low spending growth means low (or negative) growth in staff

• 2015-16 saw slower

growth in nursing staff (around 1%)

• Nursing numbers are

now falling

Source: NHS Workforce Statistics in England, Non-medical staff - 2004-2014 and earlier years, NHS Digital.

What does it mean: performance

A&E 4 hour standard, Type 1 units. Aug 2010 to July 2017 18 weeks performance, `% still waiting’, Aug 2010 to June 2017

• Ambulance and cancer waiting

times targets also in breach

• Concerns on performance
• utside of the acute sector have

been rising

• Delayed Transfers of Care
• General practice
• Mental health
• Strategies or initiatives now

in all of these areas

• Though A&E and 18-weeks

looking more stable than they have for years

60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 95.0% 100.0% Aug-10 Dec-10 Apr-11 Aug-11 Dec-11 Apr-12 Aug-12 Dec-12 Apr-13 Aug-13 Dec-13 Apr-14 Aug-14 Dec-14 Apr-15 Aug-15 Dec-15 Apr-16 Aug-16 Dec-16 Apr-17 84.0% 86.0% 88.0% 90.0% 92.0% 94.0% 96.0% Aug-10 Dec-10 Apr-11 Aug-11 Dec-11 Apr-12 Aug-12 Dec-12 Apr-13 Aug-13 Dec-13 Apr-14 Aug-14 Dec-14 Apr-15 Aug-15 Dec-15 Apr-16 Aug-16 Dec-16 Apr-17

More for less: the NHS and social care response

• Population-based, integrated care
• 44 Footprints and new ACSs being formed
• Builds on Vanguard experience

STPs/ACSs

• Carter, Naylor Review, GIRFT and Right Care
• Backed up by central controls and incentives
• And action on costs – pay and prices

Efficiency and costs

• Focus on A&E for now
• First moves on access to NICE-recommended

drugs and procedures/medicines of low value

The offer

Bringing it all together

• How to balance:
• Short term agendas on finance and performance
• Long term agendas on relationship building and moving to more

integrated systems in planning (STPs) and delivery (Vanguards et al)

• But there are strengths:
• There is a platform for action
• The direction of travel is much less contentious than it was, for example

in the 2012 Act or in the market+choice reforms of the previous decade

• The public care
• Are we missing something?
• The Noughties looked to raise activity quickly – a lot of effort went into

capacity planning and the profiling of demand

• Some of this was forgotten in the final years of plenty
• As the balance between capacity and demand again gets tighter

understanding this relationship may provide a (quicker) win