UK: The Year That Was And The Year Ahead

Last Updated: 8 January 2014
Article by Karen Taylor

Most Read Contributor in UK, August 2017

2013 was the year that finally put quality ahead of finance as the overriding imperative for the NHS. The impetus for this was the February publication of the Francis Report and its conclusion that the Mid Staffordshire Trust had exhibited "a pervasive negative culture and tolerance of poor standards and that a host of organisations had failed to detect and remedy safety concerns that patients and the public had been trying to raise for years".  The repercussions were massive and were quickly followed by the Keogh review of 14 failing acute trusts that had been persistent outliers on mortality indicators. This was swiftly followed by enhanced Care Quality Commission (CQC) inspections of a further 12 trusts aimed at establishing a future inspection and rating system for hospitals. There was also a welcome increase in the attention given to nurse staffing as well as on the capability and capacity of urgent care services.

In November the Government's full response to the Inquiry accepted, at least in principle, all but nine of Francis's 290 recommendations. Key actions include:

  • a tougher approach to the inspection and regulation of NHS organisations
  • additional duties on providers and professionals to be open with patients in the event of a serious mistake and
  • a range of centrally determined  initiatives designed to develop the capability of individual organisations and the system as a whole to improve quality and safety. 

These interventions also appeared to put the final nail in the coffin of the policy ambition to "Liberate the NHS", especially given the news that the Prime Minister was requiring weekly briefings on the state of Accident and Emergency Departments' performance and the Secretary of State's  weekly calls to Chief Executives of trusts that are struggling to cope.  With an avalanche of media coverage about an NHS deemed to be in crisis, these latter interventions are in part a reflection of the Government's real concerns that the NHS's is unable to manage itself locally but also the need to show the voting public that they take seriously their fears about their most valued public service.  

So what might 2014 have in store for the NHS?  It seems likely that the perception that the NHS is in crisis will continue, fuelled by increasing media scrutiny in the run up to the 2015 election.  There is already evidence that increasing  numbers of NHS organisations are anticipating financial deficits in their 2013-14 accounts and that the NHS's financial sustainability is likely to deteriorate further over the coming months.  Furthermore, the much lauded ambition for a more locally responsive, integrated health and social care service is likely to flounder in the face of the continuing financial, cultural, and leadership challenges.  Of key concern will be continued difficulties in accessing effective emergency and urgent care services, particularly for the increasing numbers of frail elderly people who will be feeling the impact of cuts in social services.  It is also unlikely that CCGs will be able to make the much needed changes to the way they commission and fund services quickly enough, or reduce the unacceptable variations in performance seen across all four UK countries.

In 2014 clinical commissioning groups and health and well-being boards should start to feel more confident about flexing their combined muscles but how effective this will be will depend on local leadership and willingness to re-design services around the public and not around the professionals providing care.  Meanwhile confusion over accountabilities will continue, provider organisations will need to focus their attention on responding to NHS England's request for five year plans and strategies, while introducing 24/7 care and firefighting increasing demands for services.  Specific issues that are likely to prove challenging include: increasing evidence of staff shortages; problems in meeting demand for primary care; delays in referrals to and in obtaining the results of diagnostic tests; increases in A&E and elective waiting times and in delayed discharges; as well as poor staff morale, recruitment and retention.  Not to mention continued local resistance to much needed service reconfigurations.

There are however some positives that we can expect to see taking shape in 2014, which could, if adopted quickly and at scale, start to make a difference. These include:

  • development of social, mobile, analytics and cloud tools to change how providers interact with patients and with each other, this will also drive new partnerships and collaborations
  • improved access to personal health records and greater transparency over costs and outcomes should help to change peoples' behaviours and their relationships with providers – helping patients to move from being passive recipients of care to become more active partners, who feel more confident in making choices and in self-management
  • new ways of working and different staffing models to respond to the capacity and capability challenges facing the existing workforce. This will be helped by the adoption of new, increasingly competitively priced, mobile technology to create a more digital-savvy healthcare workforce that can leverage technology to engage more effectively with patients both in hospitals and in the community
  • the development of precision medicine and a focus on specialty products means pharmaceutical companies will work differently with the NHS and will adopt new approaches to drug development, pricing and prescribing.  Likewise, the development of companion diagnostics will result in new collaborative ways of working and more personalised medicines
  • improving uptake of lower cost, more mobile diagnostic equipment will improve access to diagnostics and help develop new approaches to managing long-term conditions.

All of the above depend on finally embracing the use of technology in the health service's interaction with service users. 2014 is undoubtedly going to be a challenging year for the NHS, for the industries that supply it and the patients that depend on it. But with adversity comes opportunity and those who are bold and prepared to take risks in adopting innovative approaches to healthcare delivery will have a lot to gain.  More than £150 billion will be spent on meeting the healthcare needs of the UK population, finding ways to do this more efficiently and cost-effectively will not only improve the health and well-being of the population  but will  improve the standing and productivity of UK PLC.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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