Mind the gap

by Mark Orchard

02 February 2017


Let’s keep perspective and a focus on ending 2016/17 in the best possible financial shape.

Unless you were hiding under a rock, you will have been unable to avoid the early January media frenzy. Even the British Red Cross chief executive – a society that has a long and valued history of working with the NHS – stood by his description of a ‘humanitarian crisis’ gripping the NHS. 

The pressures facing the health and wider social care system continued to dominate the news until the focus gave way to Donald Trump’s inauguration as US president and the continuing story that is Brexit.

In the NHS, the story behind the headlines was indeed remarkable. However, reporting is all a case of perspective. Reports chose to focus on the longest waiting times in A&E for over a decade, patients cared for on trolleys, cancelled operations and hospitals declaring major alerts. An alternative reading – albeit less dramatic – would be that NHS staff, through dedication and hard work, are coping remarkably well in the circumstances.

We also need to beware of simplistic assessments of why demand is rising so persistently. The infamous ‘graph of doom’ provided a simple illustration of how a financial gap would open up as demand rose faster than funding, and we have now very definitely entered the gap years. 

Again, we need to avoid overly simplistic conclusions about the sustained increase in demand. It is too easy for commentators – including those in the service – to oversimplify ‘the problem’ as being one that can be solved by the public being encouraged to choose services wisely. 

The pressure on A&E departments, ambulance services, acute mental health and primary care has more to do with a sustained increase in the complexity of cases – a factor of an ageing population – than large numbers of ‘trivial’ patients accessing services via the wrong door. 

While local government has faced major financial pressure, demand for social care is driven by similarly complex drivers. 

Efficiency will take us part of the way – there is so much more we can do – but on its own, this won’t forever bend the two plotted lines on the graph. 

Transformation will also make its contribution – though more preventative activities and services delivered in the community is, in any case, the right way to go. 

But we also need to fully understand the challenge we face. For example, official estimates suggest by 2039 more than one in 12 of us living in the UK will be over the age of 80, broadly double the current level. 

With such demographic pressures, it is hard to see how the country could avoid a simple national choice between increased health and social care funding or changing the services currently delivered free at the point of need for all. 

Those of us working in the service may argue that is an easy decision, but it certainly lends weight to calls for a cross-party review of future NHS and social care needs.

So what does all of this mean for the average jobbing finance professional, today? Right now, we need to exit 2016/17 in the best possible financial shape. Anything less would seriously damage our ability to create a platform for transformation over the next two years.

With just a small handful of exceptions, all inter-NHS contracts have been agreed up to March 2019. With an implied acceptance that we now need to make the money go around, our immediate focus has to be on working with clinical and operational colleagues across all parts of the service – removing any and all barriers that get in the way – to maximise our collective ability to continue to deliver for patients and service users in our local settings. 

Everyone counts, and we all have a part to play, in a year that will set the direction for the NHS as it approaches its 70th birthday and beyond.