Dealing with the downturn

A typical NHS hospital, yesterday

To coincide with their annual conference in Liverpool last week, the NHS Confederation published an interesting assessment of the potential economic trauma facing the NHS in coming years and how they might like to deal with it.

The report estimates that NHS finance is likely to reduce by around £8-10 billion in real terms in the three years from 2011. That means tough choices on what healthcare to provide to whom and how to do it most effectively.

The gut reaction in such times is to cut services across the board to hit the budget figures. The problem with this approach is it impacts healthcare immediately and damages the system for years to come.

The report warns against sacrificing long-term improvement for short term gain. As a diabetic, this is music to my ears. Diabetes is an easy target in tough times. If you neglect diabetes services for a couple of years your A&E admissions might increase a bit because we fall over hypo more often or are admitted with ketoacidosis more frequently, but overall costs don’t go up that much. The real problem hits 10 years down the line when the expensive complications of renal failure and blindness hit home following years of neglect. And of course as we’re talking economics we can conveniently ignore the quality of life implications of poor diabetes care!

Whilst I’ve previously declared my hand a fan of the concept of the NHS, I’m only too well aware that (like many large, public institutions) it is notoriously inefficient and lacking real drivers for change. As someone who recently went through a ridiculously complex 4 month process involving at least 10 NHS staff to get funding for a minor procedure that cost a few thousand less than the procedure they’d already agreed to fund, I speak from experience.

The report makes some very sensible recommendations. For example, the NHS has a massive asset base of valuable equipment and buildings that are mostly used Monday to Friday, 9-5. That’s 35 hours a week. My local Tesco supermarket opens 148 hours a week. That’s quite a difference. And when workers are crying out for appointments outside of working hours and many would probably be willing to even consider paying for such convenience, there’s surely an opportunity there?

My concern? I question the motivation and ability of current leaders to take on the tough task of driving through fundamental change.

The press over the coming months will no doubt be full of scare stories around how funding cuts mean the NHS is doomed. Let’s hope some balanced reporting also points people towards a nice little report that makes some very sensible suggestions about how Armageddon isn’t inevitable just yet if we take decisive action now.