Tight fiscal choices undertaken by NHS executives to safeguard patient care, according to a study by The King's Fund
A new study published by The King's Fund health and care charity has revealed that the National Health Service (NHS) in England is facing significant financial challenges in the coming years, particularly in 2025/26. The NHS is required to deliver a record 7.1% efficiency savings and reduce the workforce by 2%, all while managing complex care demands, long-standing staff shortages, and growing costs.
The latest British Social Attitudes survey shows that public satisfaction with the NHS is at its lowest level since the survey began over 40 years ago. The quality of care in the NHS is being impacted by these financial pressures, leading to long waits for care, treatment in dilapidated buildings, and worsening patient experiences.
To address these challenges, several reforms are being proposed and implemented under a new 10-year health plan and updated NHS oversight frameworks. The NHS aims to end routine deficit funding and encourage providers to achieve financial balance, with a medium-term goal of moving most providers into surplus by 2030. Providers are now required to prepare robust 5-year plans showing how financial sustainability will be maintained.
Power and decision-making are being devolved away from central Whitehall towards local providers, integrated care boards (ICBs), staff, and patients to enable more tailored, collaborative management and planning. Payment reforms are also being introduced, with block contracts being replaced by payment models aligned with activity, quality, and outcomes. Payments will reward high-quality, efficient care and withhold funds for poor-quality care.
A revised NHS Oversight Framework applies segmented assessments to trusts and ICBs based on financial performance and delivery against priorities, prioritizing support to those most in need and encouraging ambitious but achievable planning. The NHS should prioritize funding to deliver these reforms versus maintaining current services.
Despite sustained real terms increases in the NHS budget, the health service is struggling to live within its means due to rising demand for care and treatment from a sicker population. The maintenance backlog to return NHS buildings and equipment to an acceptable standard has been growing, and currently stands at £13.8 billion.
The Health Tech Alliance has issued a call for the adoption of Value-Based Procurement through a new roadmap. The report authors conclude that it will not be possible for the health service to do everything that might be asked or expected of it in the current economic context. They recommend NHS Trusts are set multi-year budgets instead of the current annual approach to provide greater funding certainty.
The financial strains are complex, with some newer pressures like mitigating the impact of recent industrial action and cyber-security risks, while others like inflation have been longstanding. Ministers have stated that they will need to make tough trade-offs to achieve this goal. There is uncertainty about what to expect in digital transformation in the NHS for 2023.
The government's goal of delivering major reforms for the NHS is more needed than ever. The maintenance backlog, rising demand, and financial pressures are all putting a strain on the NHS, but these reforms aim to balance costly efficiency targets and workforce cuts against the need to maintain or improve care quality. The NHS leaders in England face a challenging road ahead, but with these reforms, they hope to steer the health service towards a more sustainable and effective future.
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- The financial challenges facing the NHS in England necessitate a focus on patient care and priority areas, such as chronic diseases, cancer, and respiratory conditions.
- The digital health sector could play a crucial role in addressing these challenges, particularly through advanced technologies like artificial intelligence and data-and-cloud computing.
- Health tech innovations can help improve diagnosis, treatment, and management of medical-conditions, leading to better outcomes for patients.
- Fitness-and-exercise, nutrition, and workplace-wellness initiatives are essential components of a comprehensive approach to digital health and chronic disease management.
- Eye-health, hearing, digestive-health, cardiovascular-health, skin-conditions, and neurological-disorders also require attention within the digital health landscape.
- Science must be at the forefront of the NHS reforms, ensuring that the innovative solutions developed align with industry best practices and evidence-based medicine.
- Therapies-and-treatments must be tailored to the individual, taking into account factors like autoimmune-disorders and mental health.
- Mental health is an increasingly important concern within the healthcare system, and personalized therapies will be necessary to address the diverse needs of patients.
- Smartphones, wearables, and smart-home devices can support mental health management by providing tools for tracking symptoms, offering reminders for medication, and providing practical advice.
- Cybersecurity should be a priority for the NHS, as the increased use of technology creates new vulnerabilities that must be addressed.
- Finance plays a critical role in the sustainability of the NHS, with macroeconomic trends like inflation and the energy crisis impacting costs.
- To ensure financial sustainability, the NHS must explore innovative funding models like health-and-wellness investments and venture-capital.
- Financial management reforms can help the NHS achieve greater efficiency, reducing waste and focusing resources where they are most needed.
- Leadership in the NHS is more important than ever, with decision-makers required to balance competing demands and make informed decisions under uncertainty.
- Diversity-and-inclusion in the NHS workforce can lead to improved patient outcomes and better decision-making, reflecting the needs of the diverse communities the service serves.
- The retail and manufacturing sectors can contribute to the NHS, with firms developing products for health-and-wellness, fitness-and-exercise, and medical-equipment.
- Entrepreneurship and small-business can drive innovation and create new solutions for the NHS, particularly in the field of digital health and wellness.
- Interior design can support the NHS by creating comfortable, healing spaces for patients and staff, enhancing the overall experience of care.
- Transportation is critical for the smooth functioning of the NHS, ensuring timely access to care for patients and efficient movement of supplies and equipment.
- Maintaining and upgrading the aging infrastructure of the NHS is paramount to delivering high-quality care and patient experience.
- Private-equity, real-estate, and banking-and-insurance, including fintech, can support the NHS by providing financial resources and innovative funding solutions.
- The stock-market offers opportunities for investing in companies that align with the goals of the NHS, such as improving patient care, promoting health and wellness, and developing new technologies.
- Venture-capital can help support startups developing innovative solutions for the NHS, such as wearable tech, AI, and personalized medicine.
- Personal-finance management is essential for the wellbeing of NHS staff, with many facing financial stress due to lower wages and increased costs.
- Saving and debt-management resources can help NHS staff better manage their finances, reducing stress and improving overall wellbeing.
- Lifestyle changes, such as outdoor-living, home-and-garden, and home-improvement, can support the mental and physical health of NHS staff, helping to alleviate burnout and stress.
- Sustainable-living practices, like gardening and energy-efficient homes, can help the NHS reduce its carbon footprint, aligning with a commitment to environmental sustainability.
- Budgeting and financial planning are essential skills for NHS leaders, ensuring that resources are allocated effectively to meet the needs of patients and staff.
- Technology can support NHS leaders by providing tools for decision-making, predictive analytics, and data-driven insights, aiding in the management of the service.
- The NHS leaders must collaborate with other sectors, such as finance, industry, and entrepreneurship, to explore new solutions, drive innovation, and support the long-term sustainability of the service.
