Robert Francis QC, chair of the inquiry into the failures of care at the Mid Staffordshire NHS Trust, finds himself in an awkward position. While his report published a year ago was hard hitting about failures among management, today he found himself fronting a study by the Nuffield Trust in which NHS managers begin to suggest that what will hold back improvements in patient care is the lack of money.
Of course the NHS budget is rising, only not as fast as in the 2000s and demographic pressures are increasing demand. The IFS in their Green Budget yesterday suggested that health spending will be 9.1% lower on a per capita basis by 2018 even if, rather than seeing cuts, the budget is frozen in real terms. This is challenging. But Francis himself, in an article in The Times, says that better care might actually cost less not more.
At the margins this is because the NHS will avoid some legal costs and damages if it provides better care. At the core though, the financial argument is that better integration between services, what Andy Burnham calls Whole Person Care, will save money.
The task of such reform though is massive and there has been little serious engagement with the most difficult issues. How will integrated services be created? A gradualist approach depending on strong local leadership may mean that change doesn’t come quickly enough to forestall spending pressures. We might also reflect on whether we are making the most of the crises that periodically affect NHS services – like Mid-Staffs – and whether we are making the most of them as prompts for the wholesale reconfiguration of care and commissioning that appears to be necessary.
And some leaders are already trying to focus the national debate on money rather than accepting the challenge of reform. But equally there is no appetite among politicians for another round of health service reform. They might find it easier, strangely enough, to create a hypothecated tax for the NHS – as proposed for example by Lord Finkelstein, a Conservative Peer, columnist at The Times and former Director of the SMF – than to lead a new reform process. If that happens, and the separate funding stream for health gets reinforced, then it’s hard to see where the pressure for continuing to improve patient care will come from.