Breakfast seminar

“We’re all well aware of the financial dichotomy,” John Myatt told Care Conversation delegates. “Flat investment in health, combined with inflation in the system.”

There were three potential ways of addressing this, he said – increase funding in line with inflation, change the terms of the relationship, for example by rationing care, or seek to enhance new ways of working. The UK was “somewhat unique’” in applying almost exclusively the third of these, he stressed.

“The fact that demand and funding are largely out of kilter is not really in the public eye, and I don’t think that’s very helpful,” he said. Instead, people were more likely to believe that the NHS was fully funded and increasingly inefficient, and the 2012 Health and Social Care Act had also helped to increase polarisation in the media. “There tends to be this useful narrative of ‘the bloody hand of the private sector’, and that will only intensify with the coming election.”

The increase in private sector involvement in the NHS had largely been through organic growth, however, rather than “very visible” private sector contracts. “There has been some increase in outsourcing over the last decade or so, but that’s been slow and steady rather than radical,” he said. “In terms of the future I see no radical shift at funding level to an insurance system or large-scale top-ups.”

The role of the government would remain that of funder, provider and regulator, with the most likely future scenario a “full and flourishing not-for-profit sector with some organisations moving off the government balance sheet – a provider landscape that’s many and varied. I think that’s a good thing.”

As funding challenges continued, more consumers would be also making choices about what they could buy themselves, he stressed – especially if the system was slow to adapt to new technologies – something that would go hand-in-hand with increased personalisation in the system generally. “With the advent of things like genetic profiling, and the way we all live our lives, I believe we’re going to see a shift, with responsibility moving back to the individual, and individuals owning their own health.”

One unintended consequence of large-scale state provision had been a reduction in the care provided by families and communities, he pointed out, and the ongoing funding crisis meant families and neighbourhoods would be “increasingly picking up the slack”.

This was “not necessarily a bad thing in the long-term”, he said. “An aging population, we’re told, will bankrupt us all, but if you factor in things like their spending and the value of their voluntary work then they are actually net contributors. Seeking to resolve issues like loneliness among older people with white papers and legislation seems to me to be missing the point.”

Primary care would also change, with increasing use of telephone and online-based systems, as well as a growth in self-pay. “Overall I see a more plural world, with a greater role for individuals, families and neighbourhoods, people buying services they want and new players providing those services – a free-standing provider landscape.”

Accompanying this would be the inexorable rise of health inflation and the ongoing challenge of public opinion – with “the flames of their concerns fanned by people who want to preserve the status quo” – as well as fitful supply and under-funded services. “The private sector is scooping up the bits no one else wants, but at the same time the expectations on the private sector are very high.”

None of this was helped by aggressive competition in the sector, he said. “But the cost pressure is there, and the NHS is looking for answers.” Antipathy to the private sector from within the NHS was also easing, he stressed. “If you’re a provider that’s growing organically then there’s a growing demand gap that you can fill, and there are areas for improvement in the NHS that mean opportunities to those with good offerings.”

The emphasis, increasingly, was on “evidence rather than heritage”, he said. “The historic trend is more provision of NHS services by private sector providers. And I don’t see that changing.