By Holly Sutton on 4 August 2016
HSJ: Predictions for 2017 and beyond
HSJ editor Alastair McLellan’s crystal ball session at #NHSConfed16 (June 15-17th) brought home how predictions are not only fascinating, but incredibly useful in informing long-term positioning goals for all NHS-facing organisations.
The authority HSJ has to make detailed forecasts on how the NHS will deliver care is indisputable. As Alastair first pointed out, the digital intelligence service where I and many of our team have worked, employs twice as many healthcare journalists as the BBC.
Where many trade journals have halved in size over the past decade, HSJ has thrived. Today it employs more than double the workforce that it did ten years ago. A strategist and businessman, with an acute understanding of his audience, Alastair’s multimedia team of analysts, content developers and investigative journalists say it as it is, not how people want it be.
In case you couldn’t be there in person, here are some of the choicest quotes from the session:
STPs / CCGs:
“In the long run, STPs will be more influential than CCGs” advises Alastair. “Although they face controversy, caricatured as ‘cost cutting measures’ by local media, these vehicles of reform will see CCGs enter their twilight years by 2018 if they are successful.
“Individual CCGs cannot tackle the majority of the NHS’ underlying problems. If there was real confidence at top of the shop,” Alastair argued, “they would not have to create STPs.”
Indeed, alongside the fact the NHS is broke, STPs dominated Confed this year. Editor of GP industry digital intelligence service Pulse, Nigel Praities, shares perhaps an even stronger view on them in his recent column: “The health service will live or die at the hands of the STPs. They had better be good.”
“By 2020 the majority of people in this room will have used a paid-for healthcare service at least three times in last month,” Alastair predicted.
This is the one forecast I’d disagree with. I’d say this is going to happen much quicker – especially to the types of busy, professional, well-informed people at breakfast meetings in Confed. I used Babylon to diagnose and treat my infant son’s scarlet fever in video appointments with a UK GP four times in the week running up to Confed. All for the cost of just £5 a month. That’s probably less than I spend on telephone bills, holding for over 30 minutes, to book an appointment at my NHS GP.
“The length of the NHS waiting list will make the achievement of our current Referral to Treatment Time (RTT target) impossible,” Alastair forebodes.
“However, the A&E target won’t be scrapped. Central policymakers will want to hold onto that as people’s experience with A&E is so directly measurable.”
New care models:
“By 2020, NHS organisations from Nottingham northwards will be covered by Primary and Acute Care Systems (PACs) or Managed Care Providers (MCPs). Elsewhere, the NHS will look much as it does now,” Alastair forecast.
“Health and social care integration will be pursued as a means to an end, rather than end in itself, to deal with the range of pressures both are facing.”
“Primary care delivered at scale will be the big evolutionary change of this period.” That’s exactly as we have seen through the work of some our clients, including Digital Life Sciences.
“At least a dozen trusts will exist in chains or share a CEO by the end of the year. Acute trusts with less than £600m will no longer have their own independent board.”
“Capital finance is not available and at least some of the NHS’ current plans require this.”
“Sir Robert Naylor’s recommendations will see the NHS explore sovereign health funds and PFI-style deals to address the shortage of infrastructure investment. For every 20 deals explored – at great expense – about one will get through the Treasury.”
“People understood when the Five Year Forward View was published that NHS finances were under control, but they’re not.”
“The impact of this is that it will slow everything down.”
“However, in some areas where money is so tight that hospital chiefs believe they might as well be hung for a sheep as a goat, lack of access to finance will accelerate change.”
On this topic, Alastair took things personally: “This gets me angry that there is no laser-like focus on this from the centre – this is low hanging fruit. Progression on it is too slow.”
“Recalibrating the relationship between the NHS and the supplier sector to bring them closer together is much needed.”
“Co-payment for certain types of treatment is inevitable as the NHS has to reach a tipping point in a few years. Otherwise so many interventions will be available to people outside the UK, that the only way people can afford some novel treatments will be via a social insurance model.”
“There is an enormous pipeline of high-cost medical drugs and devices that the NHS cannot afford under the current envelope, even with the Cancer Drugs Fund. One pharma business has 23 of these types of drugs in its pipeline for release already, with the benefit so unarguable that NICE will want to approve them.”
Just a few weeks on this issue is already bubbling up, with a British Medical Journal investigation revealing the NHS is stymieing access to high cost drugs.
This issue felt most stark for me, as Alastair prophesised: “The junior doctor contract is going to monetise good will.”
He then added: “If the NHS started to pay for all free overtime people gave it, we would have a big issue on our hands.
“There is a nursing shortage in some places, while in others there is a surfeit of nurses. But we don’t really know where the extra nurses could come from, creating an overlying problem for the system.
“NHS Improvement is quietly relaxing things so the nursing shortage plus cap on agencies doesn’t produce a series of scandals.”
Another gloomy outlook from Alastair here: “I’m pessimistic about this sadly,” he said starting on this topic.
“I don’t think mental health will achieve parity of esteem except in places like here [Confed session], where it’s openly discussed.
One area within mental health that does offer hope to Alastair – and interestingly the first time he mentioned the D-word as pivotal to the NHS’ future – is when he said “Digital will be very significant in this area [mental health].”
“NHS mental health organisations are much better at dealing with these changes in the world than average NHS acute organisations, so they will do the best to adapt to this new world and prosper in it.
“Making a connection to the most innovative local authorities, innovative commissioners and partners, is the only bright future available for mental health.”
“Sunlight is the best disinfectant, as has been shown by the Morecambe Bay Hospital and Southern Health fiascos.
“The reaction of the NHS towards Southern Health belies the fact that behind the catastrophic failures there were important questions that we just were not asking. This is an area of learning, there is slow burn but very significant changes have already been achieved.
“As shown by Morecambe Bay, maternity has gone a bit wrong in this country.
“There have been various reviews on this and it is an area where choice and user preference can be quite active so we will get some change on this.”