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Health Futures Healthy_Living_Cov.qxd:Smith Institute 7/5/09 15:32 Page 1 health futures The Smith Institute The Smith Institute, founded in the memory of the late Rt Hon John Smith, is an independent think tank that undertakes research, education and events. Our charitable purpose is educational in regard to the UK economy in its widest sense. We provide a platform for national and international discussion on a wide range of public policy issues concerning social justice, community, governance, enterprise, economy, trade, and the environment. health futures If you would like to know more about the Smith Institute please write to: Edited by Neil Churchill The Smith Institute 4th Floor 30-32 Southampton Street London WC2E 7RA Telephone +44 (0)20 7823 4240 Fax +44 (0)20 7836 9192 Email [email protected] Website www.smith-institute.org.uk Registered Charity No. 1062967 2009 Designed and produced by Owen & Owen Healthy_Living_Txt.qxd:Smith 11/5/09 13:11 Page 1 THE SMITH INSTITUTE health futures This monograph follows on from recent work the Smith Institute has undertaken on health and early intervention. Over the past few years, the government has commissioned a series of reports that have helped bring a new focus to the urgent action which is required to help modernise the health service, and to make it more responsive to the needs of the citizen. But the primary focus of these reports has been to improve the existing service within the context of current pressures and expectations. Arguably, these are short-term, incremental measures, when a more radical and far-sighted approach is required. What are the challenges beyond the next 10 years? What more radical and challenging issues should government and other partners be addressing, to facilitate continuous improvement? Asthma UK The Smith Institute thanks Neil Churchill (chief executive is the charity dedicated to the health of Asthma UK) for editing this collection of essays, and and well-being of the 5.4 million gratefully acknowledges the support of Asthma UK people with asthma in the UK. towards this publication and the associated seminar. Published by the Smith Institute ISBN 1 905370 49 0 This report represents the views of the authors and not those of the publishers. © The Smith Institute May 2009 Healthy_Living_Txt.qxd:Smith 11/5/09 13:11 Page 2 Contents Foreword Rt Hon Alan Johnson MP, Secretary of State for Health 4 Introduction Neil Churchill, Chief Executive of Asthma UK 6 Chapter 1: Future challenges Niall Dickson, Chief Executive of the King’s Fund 16 Chapter 2: Active state or nudge state? Jenny Versnel, Executive Director for Research and Policy at Asthma UK 26 Chapter 3: Surviving the resource crunch Michael Macdonnell, Director of the 10 Partnership 34 Chapter 4: Meeting known challenges Andrew Harrop, Head of Policy at Age Concern and Help the Aged 42 Chapter 5: An intelligent health service Tim Kelsey, Chair of Dr Foster Intelligence 52 Chapter 6: Healthcare beyond the NHS Mikis Euripides, Assistant Director for Policy and Public Affairs at Asthma UK 62 Chapter 7: Leading innovation – a clinical entrepreneur Dr Richard More GP, Principal and Director of Avanaula Systems 70 Chapter 8: Leading innovation in public health Maria Duggan, Regional Investment for Health Adviser at NHS North West, 82 Dr Ruth Hussey, Regional Director of Public Health/Medical Director at NHS North West, and Dominic Harrison, Deputy Regional Director of Public Health at NHS North West Chapter 9: Health literacy Don Redding, Head of Policy at Picker Institute Europe, and Joan Walsh, 92 Policy Research and Campaigns Manager at Picker Institute Europe 2 Healthy_Living_Txt.qxd:Smith 11/5/09 13:11 Page 3 Chapter 10: An open health service? Counting on accountability Harry Cayton, Chair of the National Information Governance Board for 104 Health & Social Care and Chief Executive of the Council for Healthcare Regulatory Excellence Chapter 11: Changing public behaviour Martin Dockrell, Director of Policy and Research at ASH 112 Chapter 12: Devolution – limits and possibilities Professor Scott L Greer, University of Michigan School of Public Health and 124 Senior Research Fellow at London School of Economics Chapter 13: On the road to world-class healthcare? Anna Dixon, Director of Policy at the King’s Fund 136 3 Healthy_Living_Txt.qxd:Smith 11/5/09 13:11 Page 4 THE SMITH INSTITUTE Foreword Rt Hon Alan Johnson MP, Secretary of State for Health Little more than a decade ago, the presiding theme of any debate about the future of the NHS would not necessarily have been about how to improve it, but about whether it was worth saving at all. Over the past 12 years, unprecedented levels of investment and greatly increased staff numbers have radically transformed the NHS. Its reputation as a service that could only provide the bare minimum and where long waits were endemic has finally receded and, as its 60th birthday celebrations demonstrated very clearly, it is an institution that is not only valued, but also cherished by the public. There is a consensus that more or less spans the political spectrum that a national health service, funded out of general taxation and free at the point of need, is not only the fairest, but also the most effective and efficient way to provide health services. The NHS Constitution, published in early 2009, will help to protect both the values and principles of the NHS for future generations. As the contributors to this publication point out, the challenges faced by the NHS are continually evolving. Our understanding of the causes of illness is greater than it has ever been. Heart disease, stroke and cancer have long overtaken infectious disease, as the major causes of mortality in this country, and, while genetics play an important role in health, in many cases such illnesses are preventable. Smoking, poor diet and lack of exercise play a major role in our health and account for many premature deaths in the UK. While there have been tremendous improvements in people’s health and well-being over recent decades – including significant increases in life expectancy among the poorest – there is still a divide between the health of the wealthy and the health of those living in the most deprived communities. New technology presents both challenges and opportunities – the public can, and generally do, access multiple sources of information about their health. They also – and rightly – have higher expectations of public services. The public expect to be able to access services quickly and conveniently, and for them to be organised around their needs, not what is professionally convenient. The population is also older. There are now more pensioners than there are children, and there will soon be more over-65-year-olds than under-25-year-olds. This is, first and 4 Healthy_Living_Txt.qxd:Smith 11/5/09 13:11 Page 5 THE SMITH INSTITUTE foremost, a tribute to the NHS – the first generation to grow up with access to free healthcare are the longest-lived in this country’s history. But an ageing population raises important questions for all public services, not least for the NHS and on the future funding of social care. All this means that demarcations between health and social care (and, indeed, all public services) are increasingly irrelevant, and the distinction between what is considered “public health” and what the NHS does feels even more artificial. This thoughtful collection of essays provides an overview of the profound impact some of these questions are having on the NHS, and the practical measures that health and social care professionals are taking to deliver better services. It is a stimulating and welcome contribution to the continuing debate on what more must be done to improve the health and well-being of people in this country. 5 Healthy_Living_Txt.qxd:Smith 11/5/09 13:11 Page 6 Introduction Neil Churchill, Chief Executive of Asthma UK Where are we now? The good news Historic sums have been invested in healthcare in recent years. OECD and World Bank figures show that total health spending accounted for 8.4% of GDP in the UK in 2006, compared with an average of 8.9% across OECD countries1 – nearly meeting Tony Blair’s famous televised policy commitment to match average EU health funding levels by 2005.2 There is no doubt that this substantial investment has had an effect on provision. Latest figures show that in 2006 the UK had 2.5 doctors per 1,000 population, up from 1.9 per 1,000 population in 1998, but still below the OECD average of 3.1.3 Similarly, there has been a notable increase in the number of nurses in recent years. In 2006 there were 11.9 nurses per 1,000 population in the UK, compared with 8.0 in 1998. The OECD average was 9.7 nurses per 1,000 population in 2006. The investment has been essential in creating a platform for improved performance. The bad news The improved performance has not yet arrived to the degree that was expected. Greater numbers of doctors and nurses will not improve our health if we cannot encourage them to work in areas of high need. Senior government officials admit that we are losing the fight against rising trends in obesity and diabetes, both of which undermine the NHS’s long-term sustainability.4 Key reformers stress that we cannot continue with business as normal. Professor Paul Corrigan, one-time adviser to former health secretary Alan Milburn and more recently top strategist at NHS London, argues: “If we continue doing what we are doing, the NHS will go bust. We need to radically change the value proposition, the relationship between outputs and outcomes.”5 Hoped for progress appears elusive.
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