Breakfast Seminar

“When the coalition government got in it made a number of promises about the NHS,” Roy Lilley told Care Conversation delegates. “It said it would ring-fence funding, and put more money in – which they did, in fairness.”

This increase, however, amounted to about 0.1%, he said. “It gave the Prime Minister the ability to say, ‘We’ve put more money in’, but demand’s been going up by 4% a year, so you don’t have to be a rocket scientist to see that demand is increasing much faster than funding”. Some cities had seen demand increase by closer to 9%, he stressed.

If this flatlined funding continued alongside increasing demand, the NHS was heading for real trouble, he said, with most commentators agreeing that it had been “hobbled” by the 2010-2015 funding window, as well as the £20 billion in savings that had been demanded. “So, did we save the £20 billion? No one’s had a pay rise, some of the expensive pharmaceutical products have become generic, and the tariff’s taken a couple of hits. But can we hear that money rattling in the tin? Not giving someone a pay rise is not the same as making savings.”

While funding had increased slightly for the 2015-2020 spending cycle, it was still effectively flatlining, he stressed. “The NHS is clearly in a very difficult place financially, and demand is going through the roof.” Much of this was the result of primary care’s failure to cope with that demand, he pointed out.

“Primary care funding has been cut from just over 11% to just over 8% of the budget, we’re pushing more and more work in, we can’t persuade enough young doctors to become GPs, and there’s problems with access and with the estate. For most people, primary care is now irrelevant. It’s in a very difficult place.’

If the intention was to manage the decline of the NHS then “we’re not doing a bad job”, he said. “We’re giving it a soft landing.” There were 22 Trusts in special measures and the Care Quality Commission (CQC) had brought about “no significant improvement”. There had also been the advent of another regulator, Monitor, to oversee the market in healthcare. “But, as you may have noticed, there is no market.”

Many private providers had pulled out of the NHS because they were losing money, he told delegates, while the care home market was also looking at “swathes of bankruptcies” without an urgent funding increase. “It’s a pretty gloomy picture. So what are we going to do about it?”

The NHS ‘vanguards’, established earlier this year, were making changes through vertical integration and giving people freedom to work together – such as hospitals having control of primary care so they could manage admissions more effectively. “But will they be looked at as the New Jerusalem? I don’t think so.” None of the changes had been consulted on, or put out to tender, he said. “What is Monitor doing about that? Well, by and large it’s a failed organisation” – one that was now having a “lick of paint” and recognising that there was no money in the market, he said.

“So, things are still very, very tight. A third of hospitals have no Chief Executive, so there’s a dearth of leadership as well. I know there are a lot of things the NHS does badly, but there’s no great difficulty in coming up with new ideas in the NHS. The difficulty is getting rid of the bad ideas.”

This took investment, time and willingness, he said, all of which were in short supply. “The difficulty we have is that we’ve created a very, very defensive culture – there’s no repository for what’s good in the NHS. We don’t tell people what’s good – we just turn up with the CQC and tell them what’s bad. People are frightened to admit there’s a problem or ask for help.”

The investment the NHS so badly needed was not just money, he told the seminar. “Everyone’s got a smartphone – or will have one – so why don’t I have the NHS in my pocket?” The institution was fundamentally unchanged since it was created, he said, despite far longer life expectancy and the associated chronic conditions. “We’ve got an NHS that was designed to do something well in 1948 trying to do something entirely different in 2015. If it was a business you’d have changed it substantially. But they haven’t.”

It was vital to “start with the patient and work backwards”, he stated, designing services around the customer rather than taking existing services and “trying to fold them around” people.

The ultimate problem, however, remained the lack of political will to properly increase funding. “The damage that was done in 2010-2015 is the legacy we’re struggling with, and another five years of austerity will just about see it off. We should be proud of what we’ve got, but I’m afraid we’re just complacent.”