Bank on the internet to save the NHS

The fact that the NHS is now facing a decade-long financial mismatch between resources and demand is well accepted. While there are some who believe, against all the evidence, that more money will turn up from somewhere, the majority of leaders within the NHS accept that over the next 15 years we will have to significantly improve health outcomes for the same resource.

To deal with this challenge, the NHS Confederation – in partnership with our members and other organisations – has been looking at how the health service can extract more value out of its existing resources. We have increasingly had to think more radically than the traditional approaches to NHS cost savings.

Other services and industries do this all the time. For instance, nearly 20 million people now use internet banking – managing their own money in their own time in ways that had previously been done by others. Of course, customers do not do this on their own: the infrastructure to make online banking possible requires a very complex web of organisation that encourages people to use their time and expertise to multiply the value that is being invested from the industry.

‘We have to take action now to avoid the standards of services falling and budgets spiralling’

In the next decade healthcare is going to have to develop a similar approach to improving the capacity and knowledge of people to self-manage their conditions. A third of the UK population currently lives with a long-term condition, accounting for half of all GP appointments and two-thirds of outpatient appointments. And approximately 70 per cent of the total health and care spending in England is attributed to caring for people with long-term conditions, meaning 30 per cent of the population accounts for 70 per cent of the spend.

Change and evolve

The pressures on the system are building and we know we have to take action now to avoid the standards of services falling and budgets spiralling. To achieve this we will have to change and evolve, just as other industries have done, investing in services that increase the capacity of very different sorts of patients to better manage their healthcare.

If the NHS is going to invest in creating that increased capacity, the money for that investment is going to have to come from within the existing resources of the NHS.

‘We need a widespread change to thinking and culture that involves patients in shaping their own care’

This dilemma is not unique to our population or our health service. The need to innovate and change has been recognised in the NHS Confederation’s work with the World Economic Forum, which is currently highlighting the need for countries to reorient their healthcare delivery to wellness support models based on supported health maintenance and enhanced self-care. But changing the DNA of the NHS to genuinely see people as “assets” rather than “needs” is challenging, to say the least.

We need to go beyond making the moral case for better self-management and systematically look at how to make this work right across the system. We need a widespread change to thinking and culture that involves patients in shaping their own care and the services that are delivered to support them.

Making it a reality will depend on various business cases being made to clinical commissioning groups to invest money in the services that help bring care out of the hospital and into people’s homes – to transfer resources away from professionals and into patients, families and communities. Ultimately this might also be seen to require a simultaneous transfer of power from professionals to patients, but the good news is that power is not a finite resource and the more we empower patients and families, the more power the NHS has overall to be sustainable and successful.

‘The more we empower patients and families, the more power the NHS has overall to be sustainable and successful’

This is not something that the NHS can treat as an interesting hobby. In November 2012, Jeremy Hunt emphasised the expectation on the NHS to deliver change in the NHS mandate, which placed significant emphasis on empowering and supporting people living with long-term conditions. The mandate specifically stipulates that NHS England’s objective is to ensure the NHS becomes dramatically better at involving patients and their carers and empowers them to manage and make decisions about their own healthcare and treatment. It recognises that for all the hours that most people spend with a doctor or nurse, they spend thousands more looking after themselves or a loved one.

Address this challenge

Nesta, the UK’s innovation foundation, is helping address this challenge by bringing together healthcare innovators, frontline staff, patients and their carers to look at how we can take many of the best ideas forward. In The Business Case for People Powered Health it sets out how to create services that allow people to shape their own care and argues that it could save the NHS £4.4bn a year.

If we are to really crack the nut on people-powered care then we must recognise the huge opportunities and benefits that lay ahead for the NHS and for patients, rather than be daunted by the challenges.

Mike Farrar is chief executive of NHS Confederation