All this week I am trying to unpick the five major arguments being made about the overwhelming pressures that challenge the NHS. I am trying to uncover why the way in which these arguments are made is, rather than unlocking and forcing change, making that necessary radical change more difficult.
My overarching point is that it is the posing of these arguments as a set of challenges that are in fact overwhelming the NHS. What I am trying to is to demonstrate that each challenge presents opportunities for the NHS to adapt rather than being overwhelmed.
Today I want to discuss the money.
The money is one of the main arguments that feels overwhelming. This is partly because more and more people in the NHS believe that there won’t be more and more money and that’s a bit overwhelming.
For 60 years we have all been working in a service where we have been getting a larger slice of a bigger cake. The GDP has been growing and the proportion of that GDP that has been going into the NHS has also been growing. Even in difficult times, taken over a five year period, the amount of money has gone up and up.
For the last few years it has not been going up. But many people believed that eventually normal service would be resumed and money would start going up again. Only over the last few months have more and more people begun to recognise that if we are very lucky between now and 2020, it won’t go down.
(Of course there are still some whose wishful thinking overcomes their judgment. But I hope for them that the passing of the budget last week – without a few billion extra pounds for the NHS – marked the end of that hope. The moment of maximum political pressure is the budget 14 months before an election. If the money is not found then why would it be found in the first four years of a new Parliament? No. What we have is what we will get)
As more people realise this they begin to talk about the “Graph of Doom”. This shows demand increasing every year while money stays the same. The doom comes from the growing gap – that gets bigger every year.
This gap is based upon the expectation that we will continue to do what we have done before. If demand has gone up by 20% by 2020 the expectation is that, given we will treat these new sick people in the same way as we have treated sick people before, we will need 20% more money to do it.
We heard this logic last week when the RCGP said that to meet the new demand there would need to be 10,000 extra GPs. As reported the story contained the rather odd claim that GPs might become extinct.
(That’s a very strange word to use about the future of a bit of the medical profession. Is there no little bell that goes off in people’s heads when they make these claims?)
It’s true that GPs are under great pressure from rising demand, and what some of them are doing as I discussed on Wednesday in my blog about technology, is changing the nature of their consultations with patients to utilise their time and skills in different ways.
The NHS and social care will not be treating that extra 20% of demand in the same way that we treat them now. If they (and we) are lucky we will be providing a much better service of coordinated care with much less use of emergency beds for fewer exacerbations.
The NHS is not full of people who in five years’ time will have to do what they did five years ago.
It’s not full of people who have to deliver exactly the same service that they did five years ago in five years from now.
But it is full of people, at least those over 30, who have been used to working in a service where the money goes up all the time.
What we need to do is to use the inventiveness that has been there in the past to incorporate new forms of treatment to the service for better value for money.
One of the reasons why people are not doing that is that their leadership has been talking in such gloomy doomy ways about everything – including the money.
What we need from the new leadership of the NHS is some concerted hope for the future which sees all these difficulties that have been described as “overwhelming us” as issues that provide opportunities for development.
With a bit of good leadership we won’t be overwhelmed, but will use these pressures to grow.
My last post of this month long return to the blogosphere will be about the prospects of political leadership facing these changes.