Politicians must come clean about the scale of funding constraints facing the health service, and have the courage to make the case for controversial hospital closures, if the NHS is to survive the next decade in its current form, according to one of its most influential figures.
In an interview with the Financial Times, Mike Farrar, chief executive of the NHS Confederation, an umbrella body that represents hospitals, GPs and other organisations that provide and buy healthcare, said that as part of securing a “mandate” for “planned change rather than …unplanned, unsupported, unpopular cuts”, the public needed to be persuaded that services would still be provided “but not in the same way as we do now”.
Emphasising the need to shift resources into the community, Mr Farrar added: “We won’t have 25 per cent of [hospital] beds in use with people who could have been perfectly reasonably treated elsewhere cheaper and to a better outcome if we’d have put that money into another bit of the system”.
While the government had rightly stated that it had provided a real-terms funding increase for the health service, “it didn’t say ‘but that doesn’t go as far as meeting the additional demand which we’re going to have to find by redeploying the existing resources and spending that better’. That will mean change and we’d like them to put that extra sentence on rather than give the impression that, actually, the health service was inflation-proofed,” he said.
For the past decade, he said, “we were able to meet the pressures on the service through the growth in our economy …Now in the next decade we can’t.”
Accusing politicians of all parties of failing to make the case for closing hospitals even when they were no longer “clinically safe”, he said they feared being “Kidderminstered” – a reference to a campaign to save that town’s hospital from closure which sent shivers through Westminster when it ended in a local doctor unseating the incumbent MP.
Next year would see “more clinicians in leadership roles”, as the new system under which groups of GPs would buy care for their patients began to get under way.
That created “a very powerful opportunity” for politicians and medical staff to work together to explain to the public why it would be necessary to provide services differently.
Mr Farrar said the confederation had commissioned health economists to prepare data on the cost of different kinds of treatment in an attempt to “to get [people] to think about what they can do at a personal level themselves” to ease pressure on the health service.
He compared this to the way in which people, a decade ago, had begun to consider their use of energy resources through an awareness of their carbon footprint. “Could people think about their use of health services as a kind of care footprint?” he suggested.
At a time of year when hospital admissions and ambulance call-outs for alcohol-related incidents traditionally spiked, Mr Farrar highlighted the costs they imposed on the health service as an example of how people could be brought face to face with the consequences for the NHS budget of their own behaviour.
“If there was an alcohol-related fight in the pub at the end of the street” the cost in hospital treatment for those involved, which he estimated at £12,000, could wipe out – in one incident – the annual contribution through taxation to the NHS of eight people who lived in that street.
The key, he suggested, was helping people to understand what practical steps they could take to spare the health budget.
In terms of the carbon footprint, people had “understood that if you pull the plug out, that saved so many units of emission. If they drove eco-friendly cars, that reduced emissions by x amount. What we don’t have at the moment in the health service – which is why we’re trying to work on it this year – is that currency that you can deploy at a personal level. You can think ‘well, I’m doing my bit’.”
The aim would be to ensure that “if you are worried and you think, ‘well, I do want to reduce my use of the health service …I do want to make sure that – for those people who absolutely need it – it’s always there, I can do x’. We give people a list,” he said.
By way of example, he mentioned the importance of appropriate immunisation and vaccination: “an immediate thing that you can do that has immediate benefits,” he added.
The cost of a hip or knee replacement was “just short of around £10,000”, he added, but regular exercise and maintaining muscle strength could go a long way towards preventing the need for one.
“If you were able to say, well, actually every hip operation [amounts to] four people’s annual contributions to the health service for that one operation in terms of what it costs, you start to get people to understand a little more about the scale of resources rather than …putting these big global numbers out about the NHS in aggregate,” he added.
The way in which people’s awareness of their carbon footprint had developed over the past decade indicated how attitudes could change as people began to appreciate the need to safeguard scarce resources – but only if it was “a social movement” rather than something imposed from on high, he said. “Ten years ago, if you recycled, you were a crank. Now 10 years on if you don’t recycle, your neighbours frown upon it. So, that attitude has changed and I think it changed because …it wasn’t a government, top down approach,” he said.