Fixing our NHS — what does that really mean and how does the Budget change things?

It's almost a week since the Budget was announced and we're back with Part 2 of our new series 'Reading the pulse on our NHS'. And this time we're digging into the detail of the Budget! 🔍

Nov 05, 2024

This piece follows our Linkedin Post ‘The 10 numbers we care about from the Budget’

The Times predicted that “the principle beneficiary of this Budget is likely to be the NHS”,1 and Rachel Reeves took to the world’s stage on Wednesday to set out the first budget of this new Government. In this piece, I’ll cover the impact across the NHS with a focus on general practice and health tech.

The detail 🔍

Overall, there will be £22.6 billion additional funding for the Department of Health and Social Care (’DHSC’) to support NHS England to deliver 40,000 more elective appointments and make progress towards reducing the waitings lists to the target of 18 week waits for consultant-led treatment. For context, right now 58.8% of the total 7 million+ NHS waiting list from referral to treatment happens in 18 weeks.2

The Budget includes:

£1.5 billion investment to add capacity for 30,000 more NHS procedures, 1.25 million more diagnostic tests, and new beds across the NHS estate
£1 billion to reduce the backlog of critical NHS maintenance, repairs, and upgrades (especially buildings effected by the dangerous concrete, RAAC)
£70 million to invest in new radiotherapy machines for cancer treatment
£2 billion to invest in NHS technology to run essential services and drive NHS productivity improvements
Establishing a fund to deliver around 200 upgrades to GP surgeries across England, support improved use of existing building space, and boost productivity to offer more appointments

Much of the exact spending of money will fall to DHSC and ultimately NHS England. But you don’t have to ask many people to find that, generally, once you help some of the big underfunded areas (like dilapidated estates and limited equipment) the view on fixing the NHS is not about doing more of the same. And the way this Budget seems to effect our health service certainly sets the stage for that to be true.

Tech, tech and more tech 🖥️

The £2 million investment for NHS technology signifies a focus on bringing modern tech to the NHS. The Budget sets out that money should be used to ensure that all Trusts have Electronic Patient Records (’EPRs’), improve cyber security, and enhance patient access through the NHS App.

Still 10% of Trusts don’t have EPRs.3 Moreover, when it comes to enhancing patient access with the NHS App, Lord Darzi’s review highlighted that although 80% of England’s population has registered for the NHS App, only 20% use it monthly and only 1% for booking appointments (with the highest use case being to view GP records).

To make the NHS App truly the front door of the NHS, you’d need to reform the fragmentation. You’d need join up patient records across the NHS. And you’d need to consider the way we triage and prioritise patients.

But imagine if we could make the NHS App the best example of joined up care. The right access to the right care setting to see the right person — all at the fingertips of the patient. Bringing together NHS 111, primary care, pharmacies and every other avenue patients can take. If it’s going to happen, it’ll happen during this phase of the NHS.

It has to result in a real outcome for a patient of course. I’d like to think that with radical change, it would go a long way to changing patients’ experiences of waiting at 8am on the phone to their GP. And maybe it would leave some room for supporting those at the extremities of society.

Productivity is the word ⚡

What do we mean by “increasing productivity”? If you’d like to understand productivity in detail, check out this piece from The King’s Fund. Essentially, ‘productivity’ of the health care system is measured officially by the Office for National Statistics. Their definition of productivity measures how well the NHS turns a volume of inputs (eg staff, drugs, medical equipment) into a volume of outputs (eg surgical procedures, GP consultations, outpatient attendances).4

If the data is showing that more money and staff hasn’t resulted in improved outcomes or increased productivity, then what needs to change?

At Healthtech-1, we’re rethinking the way primary care works with automation to help GPs and admin staff catchup with the mountain of work they juggle. An example of how this technology can change things is with lab report filing. When you get a test done by your GP, it’s sent off to lab in your area for analysis and the results are returned electronically to your GP. They then have to go through hundreds of these results and mark them as normal or not, and follow up accordingly.

If we brought our automation of this task to just 46% of England’s GP practices and automated half of a GP’s lab report inbox, we could add the equivalent of 2 million appointments per year.5 And a side effect of this is that instead of patients queueing on the phone lines to ask for their results, they’re texted with the outcome or next step.

The truth about general practice 💙

As much as there is hope for the NHS with a new Government, there are some sobering truths.

The King’s Fund’s Chief Analyst reacted to the Budget saying that the 3.8% real-terms uplift over two years to DHSC is unlikely to drastically improve care due to the new allocation of money needing to cover existing commitments for staff pay deals and the rising costs of delivering care.6 They say that more funding will be needed in next year’s Comprehensive Spending review to make a full shift to an NHS fit for the future.

Primary care faces 90% of patient contacts but the focus of the Budget’s detail was mostly on acute/secondary care and waiting lists. Warnings have come from the Institute of General Practice Management (IGPM) about the impact on general practice.7 They say that while there is some funding for technology, it needs to be directed towards systems that streamline administrative burdens and improve patient accessibility. Importantly they also highlight the need to look at local areas holistically when it comes to new housing developments which put increased pressure on local practices.

Since NHS England was formed in 2013, more than 1,600 GP practices have closed or merged, reducing the number of practices by 20%.8 Following the Budget’s release, BBC News has reported on the concerns about the impact on general practice from the budget’s tax hike.9 The government has suggested that the extra cost of higher national insurance contributions paid by GP practices will be taken into consideration when GP contracts are renegotiated later this year.

GP practices will need to make hard decisions over the coming months about how they deliver care in leaner ways than ever before. Technology that actually solves problems, increases capacity, and saves money will likely be key to this.

What will it take to fix our NHS? 🔮

We’ll have to wait until the NHS Long Term Plan is released in the Spring to see what meaningful change is planned. In the meantime, the Government has launched its Change campaign for the NHS — the largest public conversation about the NHS ever.

So what will it take? More money? More staff? Different rules about how to spend it or use them? New technology? Better ways to procure tech? New leadership?

What does fixing the NHS even mean? It starts with patient outcomes, staff and patient satisfaction, and cost effectiveness.

I don’t actually think it means fixing it. It means changing it. Perhaps even reimagining parts of the NHS as we know them.

I hope the Government will take the inputs from the Change campaign, as well as others from campaigns like the Red Tape Challenge10 and insights direct from staff on the front line to curate the most radical Long Term Plan the NHS has ever seen.

We need a plan for catching up with the impact of COVID and the economy on health, and a plan for running the NHS differently. That means a plan to rethink the structure and fragmentation of the NHS. A plan that levels the NHS with the modern, digital world we live in. A plan that actually joins up care for patients. A plan that stops headlines about 8am queues for booking a GP appointment or disrespectful 12 hour corridor waits. A plan which accepts the way the NHS is, not just how we wish it to be. A plan that means we look back in 10 years and are proud. A plan that actually changes our NHS.

About

We’re Healthtech-1 and we automate admin for GP practices across the country to increase access, power productivity, and create capacity.

Matthew is the Catalyst at Healthtech-1, an NHS Youth Board Member, and a Patient Safety Partner.

Further reading

https://www.thetimes.com/comment/the-times-view/article/the-times-view-health-spending-care-nhs-jkwhbctxg#:~:text=The%20principal%20beneficiary%20of%20the,increase%20productivity%2C%20this%20is%20it

https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf

https://www.ukauthority.com/articles/nhs-england-hits-national-target-for-epr-roll-out/

https://www.england.nhs.uk/long-read/nhs-productivity/

Assumptions: Each lab report takes 30 seconds to file and a GP appointment is 10 minutes.

https://www.kingsfund.org.uk/insight-and-analysis/press-releases/response-autumn-budget-October-2024

https://www.linkedin.com/posts/institute-of-general-practice-management_igpm-response-to-the-budget-activity-7258024605934567424-VXwC?utm_source=share&utm_medium=member_desktop

https://www.gponline.com/fifth-gp-practices-closed-merged-nhs-england-formed/article/1790429#:~:text=Fifth%20of%20GP%20practices%20have%20closed%20or%20merged%20since%20NHS%20England%20was%20formed,-By%20Nick%20Bostock&text=More%20than%201%2C600%20GP%20practices,fifth%2C%20analysis%20by%20GPonline%20shows.&text=There%20are%20now%206%2C495%20GP,View%20project%20in%20full%20screen

https://apple.news/AdNJO4vZ8SZGRR8z_1IKW8Q

https://www.kingsfund.org.uk/insight-and-analysis/blogs/red-tape-green-admin-works-everyone

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