Chancellor Philip Hammond and Heath & Care Secretary Jeremy Hunt are set to give a significant and welcome 70th birthday present to the NHS in July: additional funding for 2018/19 as well as a long term settlement.
What should the NHS do with this money, reportedly up to £50 billion by 2030? Here lies a dilemma.
Hospitals are buckling under the pressure of rising demand. Emergency admissions were 7% higher in January 2018 than 12 months before. If the government’s approach to the NHS is simply to maintain the status quo, a growing elderly population with multiple conditions will continue to use hospitals as their main point of access for healthcare services. The leaders of NHS Trusts, who have done a heroic job in responding to this rising demand, have now thrown down the gauntlet and are demanding at least 4,000 extra beds (equivalent to four new hospitals). When lives are at risk, public concern is high and alternatives to hospital services aren’t always in place, it is hard for leaders not to respond by calling for an expansion of services.
But this would be a mistake. There are three big reasons why we should resist investing significant amounts of new money in hospitals:
1. Demand is the main problem, not supply
Demand for acute hospital services is out of control. If we want to create a truly sustainable NHS we have to focus on addressing this. To be clear, a call for managing demand is not a call for rationing. It is about taking actions that will result in a better functioning system that produces better outcomes for people. We have a growing cohort of older people who are being admitted to hospital with conditions that could have been avoided if appropriate support had been provided earlier. A recent report suggested that one in four people admitted to hospital don’t need to be there, and IMPOWER’s own case reviews have shown that 40-70% of patient admissions in some wards could have been avoided. The impact of failing to address this doesn’t just affect hospitals: our recent work has also shown that more than 40% of demand for social care services is coming from individuals who are already accessing health services. The burden of rising demand is far-reaching.
2. People drive their own demands
Modern medical practice increasingly recognises the role that individuals play in their own health and care, and the importance of working with individuals to address a much wider set of their needs. National health and care systems must invest in personalising care around the individual – be that through a health and care plan, a personal budget, a social prescribing service or simply through a different conversation (asking ‘what matters to you?’ rather than ‘what’s the matter with you?’). Addressing people’s needs more holistically, and providing the tools and capabilities for people to manage their own health and care, will reduce demand for hospital services and improve outcomes.
3. People live in places, not in hospitals
To support people to live independently in their own homes, local health and social care infrastructure needs to work effectively. For the millions of people accessing these services, the system can be fragmented and confusing. Different organisations don’t coordinate their efforts sufficiently and aren’t addressing needs early enough, resulting in increased demand for hospital services. Programmes of activity around the new models of care have started to make headway but they need to be properly funded. There is also a need to recognise that a place-based approach needs to extend beyond the boundaries of NHS services to include social care, the voluntary sector and a wider set of community assets.
Ideas about the importance and benefits of personalisation and place are not new, but the advent of a long-term funding settlement provides sector leaders with an opportunity to sustain hospitals by investing in a wider set of local services in communities and personalising care at an individual level. They should take it.