Vidhya Alakeson
Associate fellow, Social Market Foundation
The government should extend the use of individual budgets to cover health as well as social care. NHS costs are increasingly driven by chronic diseases such as mental illness and diabetes: four out of five GP visits relate to a chronic condition. But effective management of these conditions depends far more on changing individual behaviour and daily self-management by patients than on professional interventions. By giving individuals control over the money that would otherwise be spent on their care, an individual budget allows them to put together a package of services that can meet their specific, individual needs.
The social care experience, with direct payments and now individual budgets, has demonstrated that giving individuals control can improve satisfaction, quality of life and value for money, as long as they are given the flexibility and support to make effective choices. The current policy position that excludes individual budgets from the NHS makes a hard distinction between social care and care provided by the NHS when no such distinction exists in the mind of service-users. The individual budget pilots reveal that individuals are already using their money to purchase healthcare products and services where these improve the quality and coordination of the care they receive. Building on these examples would begin to transform the NHS from a system where supply creates demand to one where demand creates supply.
Dr Tom Coffey
Chair, New Health Network
I would abolish prescription charges in England. Many of my patients struggle to pay for their medicines. A disabled Post Office worker has a pension which is just too high to qualify for exemption of medicines. He is on anti-depressants and blood pressure tablets and every month he alternates between the two as he cannot afford both. Prescription charges are free in Scotland and Wales. In England, only 11 per cent of patients pay and the administration of payment is costly. The present medical exemption system is anomalous. Prescriptions are free if your Thyroid gland is underactive but not if it is overactive. The removal of prescription charges would allow our NHS to be a national service, and on the 60th anniversary it would be a bold statement that reflected the founding principles: ‘Healthcare according to need and not ability to pay.’
Nigel Edwards
Director of policy, NHS Confederation
‘Physician, heal thyself’ might be an overused cliché, but for the NHS of a third term Labour government it might prove apt. As the NHS turns 60, learning from how doctors treat their patients could transform the NHS. We interviewed a number of the most forward-looking and a key theme that emerged was the need for a cycle of diagnosis, change and learning, which requires a revolution in the scale of feedback and measurement of outcomes and patient experience. This would ensure the service can improve itself based on patient need, experience and outcomes.
Data is key to this. The first step is to use high-quality data to diagnose where improvements are needed. To make the changes required by the diagnosis, NHS staff need the skills, time and incentives to redesign and improve their services. They need help to share new ideas, research and techniques, for example through a ‘knowledge portal’ and electronic networking and support from an NHS bank, which would give innovative ideas the opportunity to be developed and funded. A continuous cycle of measurement, improvement and evaluation that uses the skills of NHS staff and their ambition to do their best for patients is much more likely to create the sort of change we need than any tinkering with structures.
Dr Howard Stoate MP
Member of House of Commons health select committee
At the launch of the new cross-government obesity strategy earlier this year, Alan Johnson made it clear that ‘tackling obesity is the most significant public and personal health challenge facing our society today’. Yet obesity and other public health challenges, such as the growth in alcohol-related ill health, have to compete with dozens of other health issues for ministerial time. A named public health minister exists, but it is a middle-ranking post and they also have to deal with a host of other health issues such as pharmacy and health protection.
What we need is a dedicated public health minister, of cabinet rank, who has both the time and the political clout to keep public health at the top of the political agenda and act as its cross-departmental champion. They could start, for instance, by insisting that all government legislation was subjected to a public health impact assessment. This would make sure that the measures contained in each bill were consistent with our stated public health goals. What better way could there be of ensuring that every government department puts public health at the forefront of its thinking?
Darren Murphy
Former Department of Health special adviser
The NHS spends around £8bn a year on medicines, with over 750 million prescriptions issued to patients, but very little is done to ensure that the taxpayer gains maximum value for it. Prescriptions are issued but very many patients fail to comply with the treatment regime they are under. Studies have shown as many as one-third of patients not complying with their medicine prescriptions for arthritis and asthma, and as many as 83 per cent of patients with blood cancers and 47 per cent of patients with breast cancer not complying with the medicine treatment regimes for their conditions. These are not trivial conditions and not cheap medicines either. The cost of non-compliance is felt in greater levels of hospital readmission when treatments fail, higher levels of treatment failure and impacts negatively on the overall NHS budget and ultimately the levels of taxpayer contribution.
I would like to see the pharmaceutical companies given the opportunity to take more responsibility for ensuring that medicines are taken by NHS patients and not just paid for by the NHS and taxpayers. With the government’s support the pharmaceutical companies could become partners in individual patient care: using new technology to track patients taking the medicines they make; following up on patients to ensure they understand the medicine they are taking and the way they should be taken; calling, emailing and texting patients at the beginning of their treatment, and randomly throughout the course of the prescribed medicine, to ensure they are complying, providing proactive advice and support as well as watching for side-effects or adverse reactions. In this way, especially for the most expensive medicines, more people will take more of their medicines, more appropriately. This will cut back on waste and improve patient care overall for the next 60 years of the NHS.
Dr Peter Carter
Chief executive & general secretary,
Royal College of Nursing
During the next decade, the NHS will increasingly become a locally driven institution. So it will be nurses, patients and the public at the local level who will drive improvement and lead change. The move towards local empowerment is welcome. However, it throws up a key challenge: namely, preventing fragmentation. In short, how do we ensure a truly ‘National’ Health Service? Arguably, the answer lies in two connected strands.
Strand one: end the health inequalities that still scar society. This could be achieved by tackling the postcode lottery and by focusing resources on vulnerable populations to improve access to services and tackle social deprivation.
Strand two: learn from, and share, best practice. There is a huge amount of work taking place in the NHS that is world class. It is vital that we develop a mechanism to spread this best practice throughout the whole of the UK.
A locally driven health service doesn’t have to be a fragmented service. In fact equality in terms of access, standards and quality could be guaranteed regardless of where you live. Put simply, ‘local’ and ‘national’ can be two sides of the same NHS coin in this coming decade.