Challenges facing the NHS

The Forward View is clear that the NHS is facing fundamental challenges and that these are to be addressed by development of local Sustainability and Transformation Plans. Some of the challenges are common to all industrialised countries’ health systems while others are specific to the NHS.

  • Increased demand from a growing and ageing population
  • Change in patients’ health needs from one-off episodes of treatment to management of (multiple) long term health conditions
  • Patients wanting more information about and control over their care
  • Accessing and funding new treatments and technologies
  • Variations in access to and quality of care
  • Lack of coordinated care between organisations
  • Achieving parity for mental health
  • Transforming care of people with learning disabilities
  • A £30bn gap between NHS funding and patient needs by 2020/21

The first task facing commissioners and providers is to decide how to address these challenges. Before seizing on a new care model or organisational form, commissioners and providers need to be very clear about which of these challenges they are seeking to address or, assuming all need to be addressed, which must take priority in their areas.

Once that is understood, the second task is for organisations to decide how ambitious and radical they want to be in redesigning their system to meet the challenges they have identified. Ambitious and radical plans might involve:

  • One organisation taking on accountability for the whole health needs of a registered list of patients under a delegated capitated budget – an Accountable Care Organisation
  • Significant transformation in the way services are provided to patients
  • Major transfers of staff, estates and/or equipment between organisations

Alternatively, organisations might want to take a stepped approach to redesign by addressing specific challenges separately, for example:

  • Bidding for particular contracts with partners
  • Setting up shared services arrangements to deliver back office efficiencies
  • Consolidating clinical services on one site
  • Improving staff engagement to drive productivity improvements
  • Seeking investment to redevelop and refurbish estate

The third task is to make sure organisations understand their internal strengths and weaknesses and ensure they have the skills and capacity to deliver the changes needed. This includes:

  • Leadership with vision for the changes needed and the ability to communicate this to staff and bring them along
  • Project management support including to deliver commissioning and contracting models
  • An understanding of governance structures and what robust governance looks like
  • Relationships to facilitate effective engagement with stakeholders and service users
  • Access to the right advice and support

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