If the NHS is to improve care by focusing on the person as a whole, it needs to consider whole systems – and that means no one part getting more attention than the rest

The most prominent arguments within the NHS currently revolve around contracts and the tariff. But the problems facing healthcare, and their potential solutions, are much wider. We need a balanced debate, but there is a real danger that we are increasingly sidetracked by just one part of the system.

‘If the tariff is a “smash and grab” on acute providers, funding reductions for GPs have been just as punishing’

The NHS is, as usual, focused on solving immediate problems which, in reality, need long term solutions.

There is little doubt that the proposed tariff represents a significant challenge for acute and specialist hospitals. Aside from the real financial implications, it comes at a time when emergency and elective activity is increasing.

Regulation is also a growing burden and hospitals are understandably struggling to work out how these pressures correlate with the need to do more for less.

But it is essential that we see the NHS and the patient needs as a whole. Ask any mental health provider, ambulance service, GP or community nurse, and they will all be as concerned about their ability to meet demand and their future sustainability. 

System-wide pains

If the tariff has been described as a “smash and grab” on acute providers, GPs, for example, will cite a gradual but sustained reduction in comparative funding, which has been just as punishing.

CCGs, with their whole population responsibilities, have a central role in this, with a view across the system and the need to balance competing pressures of all sectors including primary, secondary and community services.

‘We must not allow the tariff debate and finances to derail the forward view’

They are closest to patients, clear about the need to improve out of hospital care, and work with others to achieve better services.

They are also placed at financial risk by provider unsustainability, and have already felt the impact of the £1.9bn better care rund contribution. There simply isn’t a CCG pot to raid.

Keeping the strategy in view

The NHS Five Year Forward View established a clear vision for the NHS, as well as an essential shift of funding towards community services and prevention.

If the NHS is to remain sustainable in the long term, we must not allow the tariff debate and finances to derail this strategy.

‘We must not allow the tariff debate and finances to derail the forward view’

We know there is one pot of limited money, and that an increase in funding to acute providers will have to be funded from reductions elsewhere.

It is absolutely right that we ensure hospitals are sustainable and funded for their activity, but the debate must shift towards a whole system view and not descend into a provider-commissioner split, with funding going to those who shout loudest.

In my view, we need a number of actions:

  • a clear consensus that the forward view represents the future vision for the NHS;
  • a commitment from all political parties to fund the gap identified in the view (the NHS has promised to play its part). The NHS needs a longer term financial plan;
  • a clear narrative for all providers setting out the means and timescales to shift funding and improve out of hospital care;
  • a robust conversation and agreement about the balance between generalist and specialist care that should be commissioned within the NHS funding envelope;
  • a tariff that reflects this timescale and is for a longer period than one year to allow longer term planning;
  • a competition policy that promotes integration and local determination;
  • genuine incentives for all providers to promote integration and community services, enabling a reduction in demand;
  • protection of social care without further raids on the NHS budget; and
  • regulation that is proportionate, efficient and enables providers to be their best.

These actions would need system leadership, a view across the NHS and a clear focus on patient care. NHS Clinical Commissioners is committed to working with others to find the solutions.

If we are to genuinely consider the person as a whole, we should do the same for the NHS.

Steve Kell is a GP, chair of Bassetlaw Clinical Commissioning Group and co-chair of NHS Clinical Commissioners

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