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Mind the gap: the NHS funding question

Dr Janet Harrison, director of MSc Healthcare Management and Governance Centre for Information Management at the School of Business and Economics, Loughborough University, explores the role of training and development in tackling the NHS funding gap.

The general election planned for May 2015 has kicked the NHS back – as usual and once again – into the political spotlight. Plans for changes to the NHS have been on all the political parties’ minds and voiced in conferences these past few months.

There are various causes attributed to the need for changes in the NHS: the recent disasters and terrible events that have unfolded in Mid Staffordshire resulting in a public inquiry and the publication of a report by Robert Francis QC, and the subsequent review by Sir Bruce Keogh, ‘Review into the quality of care and treatment provided by 14 hospital trusts in England’ (2013); the demographic problems of an ageing population – the NHS now looks after more pensioners than children; we have a growing population – there will be three million more people in England by the end of the decade; disease challenges – obesity, dementia, and multimorbidity continue to affect more and more of the population; more expansive and more expensive treatments are being developed and patients wish to be treated by the best available treatments.

It is acknowledged by all political parties that both social and health care are bound inextricably together in these challenges.

The core of the statements and visions emerging from the political parties and the analysis of the NHS on which they are all agreed that is that there is a massive funding gap on the way for the NHS, which will impact on services, clinicians, managers and patients alike. The size of the funding gap varies in magnitude, depending on who is telling the tale. This does not make very comfortable reading for managers and clinicians in the NHS running the service for today and planning future delivery of services – or indeed the general public.

However, it must be said that the NHS is not ignoring these looming and doom-laden challenges; quite the contrary. In a recent speech at the NHS Confederation annual conference, Simon Stevens, CEO of NHS England, gave a figure of £30bn as the potential funding gap and acknowledged that the NHS had been operating for the past five years with a flat rate of funding. He suggested ways forward against the backdrop of multiple, fundamental, long-range health challenges to be targeted in three distinct themes: ‘NHS Commissioning for outcomes and values’, ‘Redesigning care models’ and ‘Harnessing the coming innovations in modern medicine’.

Following and delivering these messages at trust level is the all-important aspect for change and development to be successful and meaningful. On reflection, these three themes can be interpreted and mapped successfully on the five areas for improvement in the 14 trusts from the 2013 Keogh report.

For theme one, ‘NHS Commissioning for outcomes and values’, the areas that map onto this theme are: Clinical and operational effectiveness; Patient experiences including patient’s views, patient experience data and visibility of feedback; and Safety – understanding the trust’s safety record and improving safety performance.

For theme two, ‘Redesigning care models’, the areas that map onto this theme are: Clinical and operational effectiveness, examining how the trust uses mortality data to analyse and improve quality of care; Workforce – it is essential that trusts listen to the views of staff.

For theme three, ‘Harnessing the coming innovations in modern medicine’, the areas that map onto this theme are: Governance and leadership and all of the areas for improvement given in the Keogh report. Depending on the fitness of the trust, these themes may well act as a model for all NHS trusts.

It remains the case that despite new models and suggestions for meeting the multiple health challenges facing the NHS in England, new money for the NHS has not been carefully articulated by any of the political parties yet.

Meanwhile the current coalition government has agreed to award £55 per patient to GPs for a diagnosis of dementia. In very crude terms this policy move does not fit with the massive funding gap scenario and has not gone down well with the general public and secondary care healthcare workers.

Clearly and carefully working out how to meet the new challenges for the NHS are tasks for all managers and clinicians in the NHS. When and how to rationalise the care are still the orders of the day. Equipping the workforce with more than common sense and a love of the NHS is essential, therefore education and training should be paramount in all trusts thinking and planning for the future to avoid falling into the gap.

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