The NHS in a time of austerity

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The NHS in a time of austerity

• James Gubb, Civitas
• www.civitas.org.uk/nhs

Image Source HSJ
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Public finances
Source IFS, HM Treasury
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Fiscal tightening
Source IFS, HM Treasury
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Real cuts in funding
Source IFS
5
Shortfall in NHS funding
Source IFS, Kings Fund
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Slow uptake not fully engaged
Source Kings Fund
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NHS productivity
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Driving value
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Microcosm of inefficiencies1. Use of resources
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Microcosm of inefficiencies2. Patient safety
Source DH, Programme Budget data
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Microcosm of inefficiencies3. Finished
Consultant Episodes
Source Bloor, K, Freemantle, N, Maynard, A,
Gender and variation in activity rates of
hospital consultants, J R Soc Med, DOI
10.1258/jrsm.2007.070424
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Solutions1. Pluralism
Source Christensen, Bohmer, Kenagy (HBR, 2000)
Revolutions in business generally come from new
entrants. That is why so many of todays market
leaders Microsoft and Google, Vodafone and
Easyjet are companies that did not exist a
generation ago. These companies could not have
succeeded if governments had been committed to
the continued leadership of IBM and AOL, ATT and
British Airways. - John Kay, Financial Times
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Solutions2. Cultural change

• For many years, it has become increasingly clear
  that paper safety, the ability to tick boxes to
  satisfy the government and regulators, has
  usurped patient safety as the priority in the
  NHS.
• Aidan Halligan, former deputy CMO

• We should perhaps be spending more time
  developing professional and corporate commitment
  than directly trying to improve quality
  programmes or projects quickly run out of energy
  being professional is a lifelong vocation and the
  very fuel of giving service.
• - Paul Bate, UCL

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Solutions3. Measurement and accountability

• Clinical outcomes should be measured as a
  composite of the most effective procedure, done
  correctly, safely, and with minimum discomfort
  for the patient.
• Patient experience. Providers need to understand
  what really matters to patients and improve these
  elements. A key part of this is compassionate
  care and a hospitable experience.
• Benchmarking of cost and value. What you dont
  measure you dont understand.

ARE PCTs UP FOR IT... Or do we need to
countenance more radical system reform?
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The NHS in a time of austerity

• James Gubb, Civitas
• www.civitas.org.uk/nhs

Image Source HSJ