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The NHS in a time of austerity

The NHS in a time of austerity. James Gubb, Civitas www.civitas.org.uk/nhs. Image Source: HSJ. Public finances. Source: IFS, HM Treasury. Fiscal tightening. Source: IFS, HM Treasury. Real cuts in funding. Source: IFS. Shortfall in NHS funding. Source: IFS, King’s Fund.

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The NHS in a time of austerity

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  1. The NHS in a time of austerity James Gubb, Civitas www.civitas.org.uk/nhs Image Source: HSJ

  2. Public finances Source: IFS, HM Treasury

  3. Fiscal tightening Source: IFS, HM Treasury

  4. Real cuts in funding Source: IFS

  5. Shortfall in NHS funding Source: IFS, King’s Fund

  6. Slow uptake not fully engaged Source: King’s Fund

  7. NHS productivity

  8. Driving value

  9. Microcosm of inefficiencies1. Use of resources

  10. Microcosm of inefficiencies2. Patient safety Source: DH, Programme Budget data

  11. 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

  12. Solutions1. Pluralism Source: Christensen, Bohmer, Kenagy (HBR, 2000) “Revolutions in business generally come from new entrants. That is why so many of today’s 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, AT&T and British Airways.” - John Kay, Financial Times

  13. 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

  14. 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 don’t measure you don’t understand. ARE PCTs UP FOR IT... Or do we need to countenance more radical system reform?

  15. The NHS in a time of austerity James Gubb, Civitas www.civitas.org.uk/nhs Image Source: HSJ

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