Coalition health challenge (needs to reduce demand)

I have written the opinion piece in the Health Service Journal published today, which you may not be able to access unless yo subscribe, so here’s an out-take:

The savings that need to be found are attributed to the rising costs of an ageing population and the cost of technology and the medicines bill. As the number of people living longer increases and both medical and surgical interventions increase, of course the bill rises.

But this does not account for much of the huge increase in spend over the past decade. The NHS has been spoilt and efficiency took a back seat while practice variation remained unchecked. Contracts were poorly negotiated and evaluation was neglected, leading to vastly higher costs than anticipated, with no improvement in productivity.

Power remained in the acute sector, thwarting more care in the community and integration of care pathways. Pensions remained excessive and unreformed. Demand was also fuelled by self care, responsibility and first aid becoming unfashionable in a dependency culture. Unravelling this profligacy is no mean task but has to be done.

Speaking to one senior doctor yesterday he immediately started to ask me whether the new team understand the desperate need to reduce demand. I wrote much more on this in our manifesto. It wasn’t one of the five ‘departmental objectives’ listed by the Permanent Secretary at the end of Andrew Lansley’s welcome reception, but I hope it’s a theme running through them.