The NHS is facing the most challenging period in its 65 year existence. Treasury funding will be, at best, level in real terms.
Given that demand continues to rise, drugs cost more, and NHS inflation is higher than general inflation, the health service is facing a funding gap estimated at up to £30 billion by 2020.
To make the sort of change necessary to bridge this gap will require political courage and an NHS making a well-articulated and evidenced case for change.
Undertaking such change is significantly easier in the two years after a general election, rather than the two years before.
The 2015 Challenge is a challenge to both politicians to create the space for change and to the NHS to be ready to make the change, and to do it well.
We currently have an NHS that was designed to deal with episodic acute care, in which people often died before they developed the health conditions of old age. In that service, it made sense to have hospitals serving local communities that did a bit of everything. The reality today is very different.
A significant proportion of current health needs is elderly care, as well as long-term conditions.
There are multiple overlaps between the two – elderly people with multiple long-term conditions; an increasing number of people having long-term physical and mental health problems; care needs routinely stretching across health and social care; pressure appearing in parts of the system.
In the run up to the 2010 general election, the NHS was too quiet on the challenges we faced; not enough work was done on the case for change and for being prepared to seize the opportunity after the election.
The realities of the political cycle mean that even if the health service has prepared a good case for change and effectively engaged stakeholders, it will always be the case that significant change is easier to do in the two years following a general election, rather than the two years before the next.
We know there will be a general election in 2015. It is vital that at the conclusion of the election, the NHS is in a position to get on with purposeful, planned change that addresses the real challenges the health service faces.
If we do not achieve a post-election drive for change, it is very possible that the current basis of the NHS, free for all at the point of need, will become unsustainable in the future.
For this to happen it is vital that the political parties enter the general election with manifestos that recognise the need for change and which facilitate it at local level. No political party must be allowed to get away with understating the problems the health service faces.
Having the political parties in the right place is only a small part of the necessary condition for change to happen on the scale required. The NHS needs to be working on the plans to solve decades-old problems.
The health service needs to play its part by recognising the challenges and looking at new ways of working to address them.
We will need to work with strategic partners, to develop solutions to the difficult issues. We also need to engage with the public to help them understand that the health service they need now doesn’t look like the health service in the 1960s.
The NHS Confederation is uniquely placed to be the body that ensures that after the general election the environment supports the NHS and its partners in making significant change happen quickly and well, and that both have done the work necessary to take full advantage of that environment.
For change to happen on the scale required, and in narrow timescales, there are four prerequisites, which form the objectives of the 2015 Challenge:
- Objective 1. At the 2015 general election, the three main parties share an analysis of the challenges facing health and social care, and that the analysis rings true with those in the health service.
- Objective 2. The main political parties are not overly prescriptive in their manifestos; their plans should focus on the 'what' and not the 'how'.
- Objective 3. The 'deal' between the NHS and politicians over the necessary conditions for political consent to change is clearer and can be articulated in a way that the NHS locally can ask candidates to sign up to the principles.
- Objective 4. As much of the NHS as possible should have developed plans for change in the run-up to the general election and be ready to go to consultation soon after. If the NHS starts planning change the day after the election it will not be ready to do implementation while it is still politically possible.
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