The Week 13 September 2024
Senior Researcher
This week, policy wonks have been busy dissecting what Lord Darzi’s Review into NHS performance means for the future of health reform. Our own snap analysis isn’t a bad place to start 😉. Though much of the problem-diagnosis will be familiar to NHS-watchers, we were pleased to see Lord Darzi highlight the importance of more localised commissioning, investing in NHS managers, and putting in place financial incentives to reward productivity and high-value care.
On the same day and just as importantly for the future of our health service — though less talked about — the OBR published its own report on “fiscal risks and sustainability” (don’t be put off by the name, it’s a genuinely punchy read).
The report finds that health spending is the “single most important source” of the projected tripling of our debt stock over the next 50 years. This is driven by, among other things, an ageing population, the increasing complexity of medical conditions, and an inability to boost health productivity (especially in comparison to other parts of the economy).
While other countries face similar demographic challenges, productivity growth in the UK has been especially weak. Reflecting this, per-person health spending in the UK grew at the fourth highest rate of the advanced economies the OBR analysed from 2000-2022.
Which brings us back to present challenges facing the Health Secretary. The March forecast for public spending had his department’s budget growing at around 1% a year in real-terms. Yet just to deliver the NHS’ Long Term Workforce Plan, which Labour have committed to in their manifesto, the OBR has said would cost more than triple this (3.6% a year).
If we’re to address the worrying trajectory in the graph below, it underlines the importance of any additional health spending being tied to reforms that can seriously improve population health and NHS productivity.
Onto our read of the week…
This week, we’ve been reading Rob Ede’s excellent blog on his time as a special adviser in the Department of Health and Social Care. He describes going into the Department with a view that the NHS’ problems would be solved through successfully exerting political “grip” from the centre.
He quickly found that, even with extreme prioritisation, the layers of approval and bureaucracy filtering through NHS England, the Department, Treasury and No.10 meant that teams of bright and hard-working officials were overloaded by the complexity of process involved in any given decision.
He includes the staggering chart (below) of a procurement process for constructing a new health site in Manchester as an example. A timely read for new health advisers joining the Department.
