It’s difficult to read the papers or watch news reports without seeing one reference or another about the substantial pressures facing the NHS now and in the future. One I saw this week about Devon CCG¹ provides just a single example for a single county. Devon’s end of year financial figures revealed a deficit of £31.1m – double what was expected. By the end of this financial year, this means the cumulative deficit could be over £80m and that in year savings of £64m will be required to balance the books.
Devon has its own unique challenges – geography and demography are just two. A lot of elderly retire to the far flung moors and estuaries in this county with a population of more than 1.1 million dispersed over 2,500 square miles. Regrettably, Devon is not an isolated example. Monitor² has just announced that the cumulative deficit of Foundation Trusts in England was £822m in 2014-15, compared with £115m the previous year. Making budgets is now a continuous struggle for the NHS, in the same way it is for all western health economies. It could easily become a perennial battle.
It’s not as if we didn’t see the problem coming. It got going 70 years ago when the first baby boomers were born. We should understand that this is not a temporary problem. The health demands of the ageing population are going to be around, and become even more demanding, for another 30 years at least. Of the 20 year period of the baby boom (1945-1964), it was the years 1947, 61, 62, 63 and 64 when the annual birth total was above 800,000. The 1964 cohort of 854,000 hits 85 years of age as far away as 2049. Altogether, this demographic bulge (see chart below) adds up to represent an unprecedented, continuous and growing demand for health care services which could easily split public finances, let alone NHS budgets, wide open.
There are pressures, not only on hospitals, the biggest spenders, but on every part of the health care supply chain. But in a system which has placed the district general hospital at its centre, it’s hospitals which have become the default position for many people’s health demands, whether they are scheduled or emergency, elective or not.
We see the biggest challenge facing Simon Stevens is how he curtails hospital care. The Five Year Forward View sets out a radically new set of potential care formats; the 29 vanguard sites represent a way in which these options will be established and evaluated. But all of these are pilots; past experience shows that it will take time for them to be set up and even longer for them to be assessed and the knowledge transferred to other NHS locations. All the time, the demand for health care will continue to grow and the impact on desperately full hospitals will be exacerbated.
So urgent action is required to manage the demand, to curtail inappropriate referrals and find more opportunities for patients to be treated out of hospital. We’ll be covering potential solutions in a series of blogs over the next few weeks. In the meantime, we’d like to get the conversation going and we’d be glad to hear your thoughts and ideas.