Talking healthcare - an effective national debate

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This week, I read the Nuffield Trust's report 'Feeling the Crunch'; another report highlighting the continuing crisis in NHS finance.  Last week a report indicated (not for the first time) that the NHS is the most efficient health system in Europe.  Despite this, 'Feeling the Crunch' now identifies in detail, that to achieve its 2020/21 savings objectives, and find the elusive £22BN, there will be a requirement for year-on-year efficiency savings of c4% for 2 years and then 3%.  These are productivity improvements that have never been achieved by any health system for a period as long as the NHS has consistently been faced with them,  and a stark contrast to the general level of economic productivity improvement in the UK,  which was described as flat pre-Brexit,  and was previously running at about 0.2%.

This Wednesday on BBC Radio 4's 'Today' programme, there was news that a Lincolnshire Trust might have to reduce access to A&E services in Grantham, and St Helen's CCG has decided to defer non-urgent operations and fertility treatment to 'balance the books'. Faced with these facts, Chris Hopson from NHS Providers called for a 'national debate' in relation to NHS funding.  In essence the stark choice seems to be that we either have to pay more, or expect less, and it may be both those things.  

Considering the recent Brexit 'debate', in which NHS funding played a part (that has clearly left the population confused about what the facts really were, and how the funding really works), and where other 'facts' were claimed by both sides and used to run opposing arguments (leading to one view that the public was "sick of experts"), this has prompted me to wonder; just how can a debate on this highly emotive subject possibly take place quickly and effectively?

News headlines in health, just since 1 August include stories that: the NHS has "spent £1.75m on homeopathy despite admitting there is no good quality evidence that it works" (The Independent ); that "HIV campaigners have won a battle for treatment" in England (Sky News) but that the ruling doesn’t necessarily mean the drug PrEP will be funded (NICE is still due to look at the evidence and the rest of the UK is still looking at the evidence); that "hundreds of NHS bosses are on six figure pay" (The Times), and that "Transgender Men are set to have babies on the NHS" (also the Times).   

Commentators and commissioners understandably identify a need for rationing services or extending waiting times if no other way can be found to address the funding dilemma.  Something of a debate is already emerging about whether delaying treatment can actually save money in the medium term. 

In all that I am hearing from providers and commissioners,  and in all that I have read and actually experienced of the NHS in recent weeks, a public debate about what we want and can afford from our health services seems long overdue.  The way in which we conduct it to ensure we properly inform public stakeholders in the face of a mass of conflicting information, will be critical if it is to have any value.

Click here to read the full report from the Nuffield Trust