The NHS will collapse without “radical and unpopular” changes including reducing the number of hospitals, setting up treatment hubs run by the private sector and transferring power and funding to local councils, a former health minister says today.
In a paper for the Social Market Foundation think tank, Lord Warner, a health minister under Tony Blair, says that unless major changes are made, rising demand will mean the NHS will be unable to provide services to all patients, ushering in a two-tier health system that no longer provides free universal care.
Warner, who was also a former senior civil servant, now sits in the House of Lords as a cross-bench peer. In his SMF paper, he urges politicians of all parties to have an honest conversation with voters about the urgent need for sweeping change to save the NHS from decline and failure.
The paper – The NHS: decline and fall, or resurrection? – argues that politicians must be much braver in making major changes to the way the country structures and delivers health and care services:
- Fewer, better hospitals
Instead of maintaining around 200 acute hospitals each providing a full spectrum of specialist services, the NHS should seek to have fewer, bigger hospitals able to offer deeper expertise.
Generalist acute hospitals use resources inefficiently and sometimes put patient safety at risk.
“The case for concentrating specialist services on fewer hospital sites rests on improving the quality of clinical care through using expensive and scarce skills and equipment more efficiently and improving outcomes for patients. Many of the headline-grabbing cases of serious NHS failure have suggested some hospitals and their clinicians are out of their professional depths. People have died because they probably shouldn’t have been in a particular hospital at the time they were.”
“Taking the unpopular decision to concentrate specialist services on fewer sites can have a good outcome, as was demonstrated in London when specialist stroke services were concentrated in eight centres instead of the previous. This saved an estimated 400 lives within two years and £800 per patient because they recovered quicker. If the London scheme was applied nationally, it would have saved about 2000 lives a year.”
- Independent treatment hubs
A network of specialised diagnostic and surgical hubs should be established to help tackle pandemic backlogs and increase NHS capacity. This approach has been backed by doctors. In May 2021, the Royal College of Surgeons called on the Government to create ‘surgical hubs’ across the country to reduce the large backlog of elective surgery.
Warner said the private health sector should be used to provide at least some of the services in the new hubs.
“Standalone surgical centres or hubs would reduce the backlog quicker and give patients more choice, particularly if the independent sector was allowed to compete by building and staffing new centres. Expanding elective surgery capacity would almost certainly require expanding NHS diagnostic capacity.”
- Shift money and power to community health
The current health system puts too much money and power in the hands of the NHS, meaning not enough effort is made to address public and community health problems, such as obesity. Resources should be shifted away from the core NHS and given to GPs and local authorities who should get new duties to increase the overall health of their populations.
“There is no credible machinery for driving a public health agenda that would reduce demands on the NHS. Every few years governments lumber into action and produce a public health White Paper after tortuous negotiations with Whitehall departments and interest groups like the food and drinks industry, supermarkets and the advertising world. These interests are past masters of pressurising prime ministers to dilute proposed changes, as was the case with the May government. Even now a commitment to curb the advertising of junk food is being delayed.
“Unless this ramshackle system is overhauled, obesity and other UK lifestyle choices will overwhelm the NHS.”
Lord Warner, former health minister and current cross-bench peer, said:
“The NHS is in a spiral of decline. Governments have a choice. Bumble along much as we are now and pretend radical change is not necessary. Or face up to this decline and the associated inadequate systems for reducing demand, delivering services and planning the workforce required.
Failure to be honest and take action will result in NHS services becoming less accessible to many people, especially in poorer areas where health and care needs are usually greater. Those with more disposable income will be able to buy non-NHS services more easily, often reducing NHS capacity further. A two-tier health and care sector is already developing and will continue to do so on present plans. Through the fog of government, the end of the Beveridge vision can be clearly seen.
Politicians badly need to have an honest conversation with the public and the NHS about the changes required.”
James Kirkup, Director of the Social Market Foundation, said:
“Norman Warner compellingly shows how the mounting pressures on the NHS cannot be addressed without radical change. Unless that change happens, soon, the demands of an older, heavier population will eventually overwhelm the NHS and put an end to the dream of free, universal healthcare.
“The recommendations in this paper might appear to be politically challenging, since voters might have short-term doubts about consolidating hospitals and making greater use of the private sector. But voters’ ultimate priority is a world-class health service, and such changes are the only way to deliver that service.
“Few people can match Norman Warner’s experience on health and care policy. He’s spent decades working for a better, more sustainable system that provides more and better care. As a crossbench peer, he has no political agenda, just a commitment to better public services.”
- The SMF briefing, The NHS: decline and fall, or resurrection?, will be published at www.smf.co.uk/publications/nhs-fall-or-resurrection/ on Monday 4th July at 8:00 AM.
- Lord Norman Warner is an independent Peer and former Health Minister in the Blair Government. He was a member of the Coalition Government’s Commission on Funding Social Care. He was a senior policy adviser to the Home Secretary after the 1997 Election and Chairman of the Youth Justice Board responsible for reforming the youth justice system. He has chaired government enquiries and public bodies, as well as charities. He has been a senior civil servant and worked in local government.
- Warner’s recommendations in detail:
- Reform Public Health and Prevention
The governance of policy advice (including on legislation) and the distribution, nationally and locally, of resources for public health should be placed in the hands of a new independent public body, the Office of Public Health (OPH).
all counties and unitary authorities would be required to have a Director of Public Health (DPH) as a chief officer, combined, if wished, with the post of Director of Environmental Health. Legislation would require DPHs to publish annual reports on an area’s health
- Expand Community Health Services and Social Care
Rather than expanding hospitals, much more of the NHS capital budget should be allocated to extending and improving community health facilities, including GP accommodation. This will mean a reappraisal of the Government proposal to build 40 new hospitals and using the proposed capital expenditure differently.
- Consolidating Specialist Health Services
Create a new system for determining the consolidation of specialist health services on fewer sites. Final decisions on where existing hospitals should close should be put in the hands of independent expert advisers, possibly panels of judges.
- Creating Elective Surgery and Diagnostic Hubs
The Health Secretary should direct NHS England to establish either surgical hubs or standalone surgical centres to undertake elective surgery. A commercial director could be appointed to let contracts to either the NHS or independent sector to build or run these centres.
Patients should be encouraged by NHS England to travel to any centre of their choice using a high-profile information programme to help patients make their choices
- Reforming Workforce Planning and Delivery
A new system for health and care workforce planning and delivery is required. The DHSC should be given new powers and a long-term budget to forecast and meet future NHS labour demands.
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