NHS England needs to find £22 billion in efficiency savings by 2020-21, and it seems that ward closures, cuts in bed numbers and changes to A&E and GP care are on the cards.
According to draft sustainability and transformation plans (STP) seen by the BBC, the cuts could include merging of hospitals, closure of acute services and GP surgeries being put under review.
Nuffield Trust think tank urged NHS England and the government to think carefully about how the plans are executed:
There are no magic bullets and while there may be opportunities to undertake more radical redesign of some services, most of the work is a detailed slog across a wide range of different activities. Some of the ideas being proposed are best described as 'plausible hypotheses' and there are some areas where the level of optimism about what can be achieved and the scale of effect is dubious.
For example, many STP leads we spoke to thought that hospital reconfiguration did not save very much and could actually increase costs, while others have put down significant savings. Similarly the assumption that integrated care, ACOs and demand management can deliver savings is simply not supported by the evidence; and more caution is needed about both scale and timing than some plans allow for.
A NHS England spokesman told the BBC that “this is a unique exercise in collaboration and that “it is hardly a secret that the NHS is looking to make major efficiencies”. They added that proposals were at draft stage but that local leaders would be talking to the public and stakeholders regularly.
A difficult situation
The NHS, much like local government, is an extremely complex organisation with a diverse set of needs that vary from locale to locale. We’ve seen in the past how national plans to standardise on systems and processes have fallen flat, at a huge cost to the tax payer.
Which is why it’s very difficult to simply say to the NHS: be more digital.
That being said, if the NHS’s answer to efficiency is to close and/or merge hospitals, GP practices and services, this needs to be done in conjunction with the introduction of new end-to-end digital services that reduce demand. And by end-to-end I don’t mean an app that can do everything, what I mean is introducing services that are complemented by digital where it makes sense.
Just making cuts and introducing closures is going to do nothing for maintaining free healthcare at the point of delivery. Instead it will increase pressure, service levels will drop and the private alternatives will become seen as the ‘smarter’ choice for those that can afford it.
For example, two weeks ago I needed to see a GP. And because I’m not registered anywhere, it was difficult for me to be seen (which I realise is mostly my fault), apart from going to a walk in centre.
However, I stumbled across Push Doctor - an online service that lets you book a video call with a GP over your phone or laptop for a reasonable price. The digital service was brilliant. I was able to get an appointment as soon as I wanted it and the doctor was very friendly and helpful.
I was prescribed an antibiotic, which was faxed to my local pharmacy, and that was that. All in under an hour, from my bed.
Why isn’t such a service available on the NHS? I realise I'm in the fortunate position that I could pay for this service without too much of a second thought. That's not the case for everybody.
At present, GPs do offer some online services, but as far as I can make out this is limited to booking an appointment and ordering repeat prescriptions. What Push Doctor has done is make it incredibly easy to be seen by a GP using modern digital technologies.
Equally, when I recently interviewed SH:24, I was amazed at how sexual health testing and treatment had been rethought using digital tools. The patient was still at the centre of everything, but online technologies and user research were being used to make this kind of service just as good as walking into a sexual health clinic.
Now, I realise that not everyone will be comfortable - or able - to manage their health online. But plenty of people would and I have no doubt that this would alleviate cost pressures and allow for sensible closures…where i made sense.
NHS DigitalThe track record of digital thus far has seen mixed results. For example, the potential of the care.data programme - which was intended to help map the delivery of services - was not realised because of poor planning and communication, as well as privacy concerns.
Equally, the ambition of a paperless NHS by 2020 has been called into question (not for the first time), with the head of a government review into NHS IT systems declaring that the target was “not possible”
However, the relatively new NHS Digital team has made some progress in cementing itself as a force within NHS England. For example, it recently highlighted how it has transitioned from a small discovery and alpha project into a major government programme, which is now on the Infrastructure and Project Authority’s list of government projects to monitor.
Equally, this week the organisation’s digital delivery director put out a blog highlighting new roles that NHS Digital needs and is hiring for. This is good news, considering that some of the projects that NHS Digital have been working on look pretty interesting - check the work it has done on a Type 2 Diabetes planner.
The planner is exactly the sort of digital service that could take some pressure off the NHS if it was included for a wide variety of long term conditions. Giving patients the tools they need to better manage their health, will likely reduce problems for demand in the long-term. We’ve been told time and time again how prevention is more effective than dealing with issues when they arise.
The main point here is that whilst closures in certain areas may make sense, they need to be considered within the broader scope of ‘how are we redesigning services?’. As I noted, this isn’t easy because of the structure and complexity of the NHS.
For example, if one Trust designs a brilliant app to help patients get treated via video conferencing, how do we scale that up so that it gets funding to get it to Trusts across the country? It won’t want to give it away for free. And, as with local government, there will be an element of ‘why should we do it?’. Funding needs to be given serious consideration.
The NHS Digital team have really made some promising step. But will they be able to accelerate at the pace required? They need to be designing and delivering prototypes very quickly - as the transformation plans revealed this week are talking about being signed off in October.
If we all agree that we want an NHS and we want free healthcare at the point of delivery, for everyone, then digital needs to play a major role. It makes sense and it needs to be a top priority for NHS England.