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NHS must involve public in solving financial crisis

Report examines charging to see a doctor, and further cutting costs

Louise Prime

Monday, 18 March 2013

The NHS must involve patients and carers much more in making tough decisions about its future, the head of the NHS Confederation has warned this morning. Its report Tough times, tough choices said all options should at least be considered – even charging for doctors’ visits and for hospital food – and that open, honest dialogue with the public about NHS finances is essential.

Society as a whole must become involved in the debate over making tough choices about how to respond to the tough financial pressures that the NHS faces, insists the Confederation. Already, 42% of NHS leaders say that the patient experience of care has worsened as a result of recent financial pressures, and only 34% that it has not been affected.

One option, say the report’s authors, would be to spend more. This could be done through increasing NHS income from user charges – for prescription medicines, visiting the doctor, or in-patient food and television, for example. But they point to research showing that the first two could reduce access to medicines and health care for people at greatest need, and the third would be unlikely to raise significant amounts of money anyway. They also point out that all three would be politically thorny: “Applying any charges in the UK is difficult, given the commitments from political parties of all colours to maintain the NHS as free at the point of need.”

The other three ‘tough choices’ put forward in the report are:

  • Doing nothing – but services might then run into financial deficit and need to be rationed, or decline in quality, which the report says “is never likely to be an acceptable price for dealing with fiscal challenges”.
  • Doing more for less – such as by further cutting the NHS’s high sickness rates and other staff costs, as well as making savings in procurement of goods and services. But, says the report, “Unfortunately, NHS leaders are now questioning how sustainable this strategy is, with many suggesting that the early savings have been achieved by picking off easy targets.”
  • Doing things differently – transform services to improve quality, while also making them more efficient and sustainable. But the report warns that public often object even to clinically rational changes to services, because of strong local loyalties.

The report’s authors write: “It is also likely that none [of these choices] on their own could meet the scale of the financial challenge we face, so may need to be used in some combination.”

NHS Confederation chief executive Mike Farrar said: “The NHS is facing severe pressure on its finances … This is a crucial time to show our commitment to improving the way we work and how we involve the public in decisions about their care.

“We need to talk openly and honestly with the public about why our health services need to change, presenting all the facts … If we fail to discuss these issues now, we will have no mandate for change in the future.”

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