How can we afford the kind of care we all want?
Secretary of State for Health Jeremy Hunt writes about the need for delivering safer services and lower costs in the NHS.
I will never forget the day I first met James Titcombe. This brave man tragically lost his 8 day old son, Joshua, after midwives repeatedly missed chances to spot and treat a serious infection at Furness Hospital in 2008. But instead of just accepting what happened, he decided to fight to stop it ever happening again. I found my eyes welling up as he relayed his long fight for the truth from a system that had closed ranks against him with a trail of cover-ups and collusion. I received superb NHS care when my 3 children were born but any father listening to James’s story would have felt exactly the same.
Politicians meet people all the time. But this was different. Apologising to the Titcombe family was necessary but not enough: I had to be able to look them in the eye and promise ‘never again’.
And yet - can we really afford the kind of care we all want? It is an understandable worry with an ageing population, rising consumer expectations and tight public finances. With a strong economy, the answer is yes - but only if we care as much about every pound the NHS spends as every patient it treats. Because money wasted is money that can’t be spent on patients.
It is no coincidence that the safest hospitals both in this country and abroad have some of the healthiest finances amongst their peers. Take Frimley Park hospital in Surrey, rated ‘outstanding’ for quality yet delivering decent surpluses year in and year out. Or further afield, Virginia Mason hospital in Seattle - possibly the safest hospital in the world, with costs up to 60% lower than its competitors.
Other industries have had exactly the same experience of delivering safer service and lower costs at the same time. The airline industry has halved the cost of travel and halved aviation deaths over 30 years. Road deaths have gone down as new cars have got cheaper and better. And in the public sector Theresa May’s Home Office has seen crime fall to its lowest ever levels despite a 23% budget cut. Safer services cost less; and controlling costs funds safer services.
So it is time to take a long hard look at whether the NHS spends its resources as carefully as it should. As the Prime Minister set out in his first big speech after the election, the government has pledged at least £8 billion more to fund the NHS’s own plan to transform services, including a truly 7 day offer that cuts the unacceptably high mortality rates for those admitted at weekends. £8 billion was what the NHS asked for. But with that commitment from taxpayers the time for debating whether or not it is enough is over: the NHS now needs to deliver its side of the bargain, which is to make substantial and significant efficiency savings.
To help kickstart that process, we have set out a new package of financial controls. We will wrest the initiative away from expensive staffing agencies that have been ripping off our hospitals with exorbitant rates, and require hospitals to use nationally negotiated frameworks that make use of the NHS’ collective bargaining power. We know from our tough new inspection regime that the best care is given by regular nurses in stable teams so it is time to wean the NHS off an understandable but growing addiction to temporary staffing that happened in the wake of Mid Staffs.
We are also introducing new controls on the use of management consultants in our health service, so that money is directed to patients rather than bureaucracy. Finally, we are grasping the nettle on excessive executive pay - with new guidelines on directors’ pay to ensure that rates remain reasonable and fair to more junior staff who have faced pay restraint in recent years.
The NHS’s founding father, Nye Bevan, said his mission was to ‘universalise the best’. That means an NHS providing not universal access to adequate care, but the very best care available for every single patient. This embodies the spirit of one nation, the compassionate country this government is trying to build, where we look out for each other and provide strongly support for those who most need it. But as Gary Kaplan, the visionary doctor who runs Virginia Mason hospital, says, ‘the path to safer care is the same as the path to lower cost.’
Safety and sustainability go together, and I want the NHS to blaze a trail for both across the world.