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Cash boost for NHS needed to avoid crash

CCGs are still struggling to work effectively, says report

Adrian O'Dowd

Thursday, 01 May 2014

The NHS will need a significant cash boost from central funding to avoid a looming “financial crisis”, warns a report from a leading health think tank published today.

A report from The King’s Fund also warns that GGC are not yet universally effective and smooth operating bodies despite the important responsibilities that have been placed upon them.

The report The NHS productivity challenge: Experience from the front line highlights progress made in improving efficiency in the face of the slowdown in NHS funding since 2010.

It is partly based on detailed research and in-depth interviews carried out in six NHS trusts – a mix of foundation and non-foundation trusts, and acute, community and mental health organisations of different sizes.

It finds there are still significant opportunities to improve efficiency within the health service, for example, by improving procurement and changing clinical practice.

However, given that more than a quarter of trusts were already in deficit, the authors warned that a financial crisis was inevitable by 2015-16 and could arrive sooner than that, with consequences for patient care.

The common ways of reducing costs such as freezing salaries, reducing the prices paid to hospitals and cutting management costs, had now almost been exhausted.

Despite the efforts of the last few years, the NHS budget was under huge pressure, which would be worsened by the introduction of the Better Care Fund in 2015-16 that will divert a further £1.8 billion in NHS funding to support joint working with social care.

The report predicts that on current projections, NHS spending as a proportion of GDP will fall to 6% by 2021 – its lowest level since 2003.

New funding should be used to establish a health and social care “transformation fund” to meet the costs of crucial service changes and invest in developing new models of care outside hospitals, it argues, and to make emergency funding available to provide temporary support for NHS organisations experiencing difficulties as a result of budget pressures.

The report says that CCGs as young organisations with “somewhat variable skills and backgrounds”, were not generally seen as up to speed, managerially or technically.

One unidentified person quoted for the work, says in the report: “Commissioners aren’t prepared. It feels at the moment that GPs have just been left to get on with it. There’s no coordinating support for GPs who are still very new to something we are really struggling with in certain parts of the country.”

The report authors suggested various ways to increase efficiency including more emphasis on encouraging doctors and other frontline staff to identify and lead changes in clinical practice, and a stronger national focus on collating and disseminating good practice in improving efficiency.

They also mentioned various health system productivity ideas that could work anywhere including more use of GP telephone consultations for patients to avoid some A&E attendances and reduce work pressure on GPs.

John Appleby, chief economist at The King's Fund and report lead author, said: "There is still scope to improve efficiency in the health service, and efforts to release savings should be re-doubled. However, it is now a question of when, not if, the NHS runs out of money.

“Without significant additional funding, this will lead to rising waiting times, cuts in staff and deteriorating quality of care.”

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