Breakfast Seminar

“The current debate on the NHS always seems to be moving into the ‘too difficult’ bracket,” Damien Marmion told Care Conversation delegates. “As with any organisation that goes through sequential change, that builds complexity. But I don’t think, from a structural point of view, that the NHS has changed in the direction that it needs to.”

The current situation was that public expectations were growing all the time, and politicians wanted to appease the public, he said. “This puts us in a situation where we won’t – rather than can’t – deal with it.” While the private sector undoubtedly had a great role to play, “I don’t think we’ve yet worked out what that interplay could be,” he stated.

There was no reason why ‘free at the point of delivery’ should necessarily mean wholly state-owned, he told the seminar. “There are great opportunities for partnership. In the private sector we’re very good at championing change.”
Value, quality and transparency were all ‘huge’ in the private sector, he said, but the likelihood remained that the “can is going to be kicked down the road. I hope I’m wrong – I hope we’ll get a much more plural model.”

Essentially, the NHS had remained locked in its 1947 model throughout the various eras of healthcare, he argued. The first of these was the scientific era, where “we were in deference to the specialists”. Then came the pharmaceutical era, which enabled a move towards a more population-based healthcare model and better universal funding. “I think we’ve now moved into an affordability era,” he said, with much more emphasis on reference and people’s ability to research their conditions rather than simply being told about them.

However, availability, access and cost remained significant problems. “If we’re able to lift our heads up from the current situation there are great opportunities for helping people to live longer, healthier lives. We’ve got a real opportunity to move into a new era.”

This would be an era of responsibility, he said – individuals understanding the causes of ill health and what they could do to prevent it. “It will be a mixture of lifestyle and the genetic/social, linked to the digital/connected era we’re now part of. That digital interface is very real and present, and the availability of information is increasing all the time. There’s a huge amount of data – and the analytics that goes with it – on all of us, and that will continue to grow exponentially.”

People would also inevitably become much more informed and proactive about diet and exercise, he said, while health provision would be forced to be much more transparent and “relevant to you as an individual, and the outcomes you’d like. Customers will steer the success of that digital interface, and that speed of innovation is only going to increase. There’s significant investment capital behind all that innovation.”

All of this would mean an overall shift away from ‘care’ towards ‘wellness’, he said, which meant that delivery systems would also need to change, moving away from an institutional-based system towards a home-based model. “It’s beholden of us to get into the customers’ shoes in this new era of responsibility.”

As to whether the current model of a predominantly taxation-funded system was sustainable, it was “very possible that there’s a different mix”, he said. “The Australian model, for example, is 50/50, which has come about through embracing the private sector. Is that practical or likely in the UK? With the current political system it might creep that way a bit, but there won’t be a radical change.”