Whilst Brexit is a major issue for the NHS and the cause of much discussion, pontification and works of fiction, in reality it is really a side show at the moment.
Yes, it was probably a major factor in the referendum with the claim that Brexit would allow a £350 million per week funding increase to the NHS, many of the big beasts involved in that campaign are now quietly (or in some cases noisily) walking away from that “promise” and denying any involvement with it.
Yes, the Department of Health has finally woken up to what everyone has been saying for a decade about population growth and demographic change (including Willmott Dixon Interiors at their Community Healthcare Campus at BRE’s Offsite conference and exhibition) and announced an increase in places for studying medicine. This needs to be tempered with the decision to end bursaries for nurse training with its perverse logical deduction that this will make a career in nursing more attractive to school leavers.
And yes, there is all the shroud waving that the nurses recruited from Europe and further will all have to leave because their salaries are not high enough to reach a threshold for being economically sufficiency although in practice by the time Brexit is complete most will have been resident for long enough in the UK to avoid that as an issue.
The starting point summed up well by the Nuffield Trust:
It is widely acknowledged that the NHS is facing a funding gap of £30 billion by 2020/21, with £8billion promised by the Government by 2020/21 and a further £22 billion expected to come from efficiency savings. Detailed plans to achieve this have yet to be published. However, it would require a sustained rate of productivity improvement much faster than has recently been recorded for either the NHS or the wider private economy.
At the same time, the NHS is facing a financial black hole with NHS hospitals heading for an unprecedented end-of-year (2015/16) deficit of £2 billion. On the back of the first quarter’s (2015/16) financial figures, financial regulator Monitor felt compelled to label this as the “worst” financial position facing providers for a generation.
Reaching that figure of £8 billion in itself requires some algebraic manipulation which would have impressed Einstein.
At the IHEEM Conference late last year, the keynote speech was given by David Williams, Director General of Finance at the Department of Health. He particularly focused on the contribution that the Estate had to make to the £22 billion, which he stated as being £1 billion.
He explained that the £22 billion was the difference between the current level of service and that which was required to maintain that level until 2020/21. A such, on the assumption that there would be reduction in service he had in essence already spent that money and therefore he thanked his audience “in advance for realizing these future savings”.
This £ 1 billion could be derived from a number of sources and initiatives, including:
- Implementation of the Carter Review to bring poorly performing organisations up to the current average position and thus achieving revenue savings:
- Implementing energy efficiency and other “spend to save” initiatives; and
- Creating and disposing of surplus land, to be re-used for housing developments.
A lack of capital was acknowledged; in turn meaning that innovative projects will be required…
The same critical points remain and these are the ones we are trying to overcome with our current health sector clients:
- Best use of ward space
- Identifying foreign disease – difficult due to longer incubation periods without symptoms
- Upgrading technology in wards & A&E for better patient tracking
- Patient data management
- Flexibility in space versus bespoke permanent facilities
- Speeding up the approval process
- Specialist mental care unites – especially in A&E
I will post the 3 Health Breakfast dates in the coming week for those that are interested in a wider or delivery specific conversation.