Strategic challenges for the health system

2 November 2016


Reported by Ryan Hamnett, MRC-funded CSaP Policy Intern (September - December 2016)

Spending on healthcare by successive UK governments has steadily increased since World War II as a proportion of GDP, to match the rising demand for healthcare amongst the population.

While the NHS has become the largest employer in Europe, and has had a large influence in significantly lengthening the life expectancy of UK citizens in its 70 year history, it has been consistently beset by cash shortages throughout its existence.

The strategic challenges for the economic sustainability of the NHS was the topic of conversation at a recent CSaP Policy Fellow event held in the Department of Health, which brought together Fellows from across government and industry.

The event began with a brief presentation from Chris Wormald, Permanent Secretary for the Department of Health, outlining the issues posed by increased demand on the NHS system. He explained that while approximately half of this increased demand can be attributed to changing demographics (such as an ageing population), the remainder is more difficult to determine and may partially originate from rising expectations of the NHS from the public. The discussion considered how the UK’s health system - including social care - can respond to rising demand and where other sectors might provide useful parallels.

The discussion touched on the role preventative action could play (for example encouraging exercise and a healthy diet) in reducing demand on the health system. Technology was also discussed, including the need for new healthcare technologies and innovations to find a ‘second adopter’; and administrative technologies that can generate significant cost savings if appropriate training and process improvement accompany their implementation. It was acknowledged that whilst a great deal of evidence and research considers healthcare interventions, there is less research into the management and administration of healthcare systems and process improvement within them, aside from that in the disciplines of management and public management. We also considered the role of behavioural science and expectation management in the conversation between citizens and service providers, with the example of end of life care providing a microcosm of the potential to benefit both service users and healthcare providers by better aligning the system to user preferences.

(Banner from Kevin Morris via Flickr)