There has been a great deal of speculation(£) now about what the new Secretary of State for Health, the Rt Hon Jeremy Hunt MP, knows and thinks about the NHS and healthcare. One thing is for sure, he must have had a lot of bedtime reading to do over the past few weeks. So it is out of sympathy more than anything else that I decided to distil what he should know about NHS staff and skills now, and looking ahead, into a short crash course. I’m going to talk about how the NHS is being stretched three ways, and the role that people and their proficiencies play in this.
In subsequent blogs I will go on to examine how universities are an indispensable part of this too. More detail can be found in our latest health publication “A picture of health and education” also check out our Prezi examining the UK’s need for healthcare staff and skills.
But back to the crash course.
The current and projected rapid growth in demand
As of 2012, the UK population is reckoned to be 63 million and projected to grow 13% to 71 million in 2030. But that’s not the whole story. The age groups where this population growth occurs is the key, the over 60s are set to rise by 37% – that’s 5 million more people – and soon more than one-in-ten people in the UK will be over 75. This alone has serious financial implications. Click the image on the right to see our population infographic.
On top of this population growth, the prevalence of many conditions is also changing, leading to very rapid rises in the numbers of sufferers in some cases. An article in the Lancet last year (£) predicted that obesity in adults in the UK will increase from 23% to 40% in 2030. Combined with expected population growth, the number of obese adults is expected to rise by 81%. That’s almost double. Similarly the numbers of people suffering from dementia in the UK are expected to rise sharply.
Juggling limited resources and efficiency savings
Like climate change, UK health has its own controversial “hockey-stick” chart of sorts: real terms expenditure from the late 1990s to 2014/15.
The flat-lining chart shows how real-term spending has effectively been capped and if you factor in the growth in demand, the NHS is being asked to do more with the same resources. Part of this is reflected by the infamous £20bn Nicholson Challenge, equating to roughly 4% savings per year. A private sector organisation implementing a full-scale Lean 6 Sigma programme with total workforce buy-in would expect savings of 2-5% per year therefore this £20Bn challenge could be one of the toughest efficiency targets ever implemented in an organisation of this size.
As if that weren’t enough, we have reforms, too
The word ‘reform’ may not go far enough. Revolution or seismic shift could be more appropriate.
The publication of Equity and Excellence: Liberating the NHS in July 2010 heralded the start of a tumultuous period of change in the NHS. While the paper alluded to the demand and cost pressures facing the NHS, nobody would refute that its premise is more ideological. The paper called for the dismantling of many established entities and the creation of a plethora of new ones, most to be up-and-running for April 2013. We’re now about six months from the full realisation of a ‘liberated’ NHS and the rate and scale of organisational change is extreme.
How does the workforce and education fit into all this?
Many commentators agree that the NHS is its staff. If our health services are being stretched three ways, it’s the staff that must accommodate but also overcome this tension.
Over 2 million people in the UK work in health and social care and around 1.7 million people work in the UK NHS. These staff can be broken down into the categories below. There are close to one million clinically trained staff, including doctors of all kinds, nurses, midwives, health visitors and Allied Health Professionals.
Looking ahead at service configurations, future care will have to be effective but also cost-effective. Future patterns of provision will depend on:
a focus on promotion and prevention
shifting care closer to home
using new service models
The success of these developments will ultimately depend on the workforce as they ask for new skills, new or different personnel and new ways of working. In short, people and proficiencies are the answer. It is here that UK universities play a vital role; not only by supplying and developing the healthcare workforce but also by being the crucibles for service innovation and excellence.
So is the workforce secured for this challenging future ahead?
Spend on health education – the investment in the next generation of health professionals and the support of the current workforce – has not kept up with rises in healthcare spend and is now flat in cash terms.
What does this say about the sustainability of the staffing and skill levels in our health services? How does this reconcile with the triad of growing and changing needs, capped investment and severe service upheaval?
If Aristotle ever told his students that “education is an ornament in prosperity, a refuge in adversity”, he was probably talking about turning to personal development in times of individual hardship. But perhaps there’s a message for managing the NHS in its own time of difficulty: staff and their skills are not the victims of, but rather the vehicles for overcoming adversity, and so surely there has never been a more important time to at least maintain investment in education and training.
So, to sum up this crash course: for the NHS, let education be a refuge in austerity.