The BMJ recently published four articles to answer the question
Can the NHS cut costs without substantially damaging the quality of health care?
- No by John Appleby, chief economist, King’s Fund
- No by James Owen Drife, professor of obstetrics and gynaecology, Leeds General Infirmary
- Yes by Paul Corrigan, management consultant and former director of commissioning, NHS London
- Yes by Rebecca Rosen, senior fellow, Nuffield Trust
The ‘No’ articles don’t surprise me too much. There are some good things in the ‘Yes’ articles including the clinician led strategy in Rebecca Rosen’s piece and the principle of encouraging self-management in Paul Corrigan’s article. Though I have problems with the similar suggestions they make that we need to get the financial incentives right – through micro incentives in Rosen’s case and tariffs in Corrigan’s. Also the suggestion by Rosen that data linkages hold part of the key, while not incorrect, is a diversion that will distract from more immediate and fundamental tasks.
The answer to the question is “Yes, the NHS can cut costs without substantially damaging the quality of health care”, but the key is to focus on patient needs and to design the system to meet them quickly and effectively. That means a mixture of treatment and care at home, locally and in specialist centres. How you determine that mix must be derived from a study of demand.
The big problem that all analysts and commentators agree on is that demand is rising and treatments getting more expensive. The trouble is that while the future is daunting, the today’s system is not designed to even meet the current demand. There are too many members of the public who are getting treatment too slowly and others who get over treated and then rushed out of beds only to be readmitted. We seem to get it wrong on both counts.
It is only by really getting to grips with present demand and then matching provision to that need that the system will flex as it rises.
The system of commissioning in the UK is too reactive and cumbersome to plan ahead for the coming generations of elderly people and high-tech treatments. The plan seems to be based on following the money and adjusting tariffs in place of following patient care.
Give the right care and the budgets follow.