Stevens makes pitch for NHS funding increase

23 Oct 14
The NHS in England will face a £30bn shortfall by 2020/21 and both funding increases and changes to provision will be needed over the next five years to deliver improvements, health service leaders have said.

By Richard Johnstone | 23 October 2014

The NHS in England will face a £30bn shortfall by 2020/21 and both funding increases and changes to provision will be needed over the next five years to deliver improvements, health service leaders have said.

Financial pressuresbeginning to hit services in England, a King’s Fund quarterly survey has found.

The Five Year Forward View, published today by NHS England chief executive Simon Stevens with five other sector bodies, stated that, although the service had weathered recent financial storms, it now was at a crossroads.

‘As a country we need to decide which way to go,’ Stevens said as he published the plan.

‘The Forward View represents the shared view of the national leadership of the NHS, setting out the choices – and consequences – that we will face over the next five years.’

He said that it would be possible to improve and sustain the NHS over the next five years if there was substantial change across the sector as well as extra government funding. Spending on the NHS has been ringfenced but frozen in real terms by the coalition government since 2010.

Among the scenarios set out in the report, Stevens said the funding shortfall – the difference between demand and the funding available – could only be closed entirely over five years through ‘staged’ increases in spending. This should be based on ensuring that funding levels are maintained at the same level of per person spending in real terms, which could amount to as much as £8bn a year.

Extra money was also needed to develop new models of care that could increase the annual efficiency gains in the service from its trend of 0.8% to between 2%-3%, Stevens said.

Among the proposed reforms was a call for GP practices to be allowed to join forces into single organisations that provide a broader range of services including those traditionally provided in hospital.

New organisations should also be created that could provide both GP and hospital services together with mental health, community and social care.

In addition, specialised services such as cancer treatment should be consolidated into centres where there was a strong relationship between numbers of patients and the quality of care.

Such changes will need to be based on local conditions, Stevens added.

‘England is too big for a one-size-fits-all plan, and nor is the answer to simply let “a thousand flowers bloom”. It’s horses for courses.

‘The NHS continues to be highly valued by the British people. But what’s great about the NHS cannot disguise what needs to change in the NHS.’

The Five Year Forward View is a collaboration between Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England, and is the first time all the bodies have set a clear sense of direction for the whole service.

Monitor chief executive David Bennett said that if the NHS was to provide the best service it can to the public, and live within its means, it has got to change the way it delivered care.

‘The NHS will do its best to achieve this, but we do need to ensure that funding reflects our growing population, and to invest in making this change happen in order to get all the productivity improvements we could achieve.’

The Forward View also highlighted the need to do more tackle the root causes of ill health through a ‘radical upgrade’ in prevention and public health.

Public Health England chief executive Duncan Selbie added: ‘We are fully aligned with the actions set out here and agree that all this is possible with determined leadership from all of us.’

Responding to the report, Health Foundation chief economist Anita Charlesworth said it had confirmed that funding pressures would rise by £30bn by the end of the next parliament without further action.

‘In the Forward View, NHS England sets out three scenarios for how to manage the funding gap [and] they all require more money. The sums involved are large – by 2020/21 if the NHS carries on in line with past trends it would need £21bn extra if cuts to quality and access are to be avoided.

‘Even with the most stretching and optimistic productivity assumption, the Forward View shows that the NHS will need an additional £1.5bn next year, rising to around £10bn over and above inflation by 2020/21. This would allow the service to hold spending per person constant in real terms and meet the costs of an ageing population.’

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