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NHS reform at pace and scale

After the so-called NHS “winter crisis”, it may seem strange to say this, but I am more optimistic about the progress of health
reform than at any time during Reform’s 15 years so far.

Interviewed in February, Jeremy Hunt rightly said that the solution to the problems of overcrowded hospitals is the Government’s “plan”, as he called it. The existence of the Five Year Forward View, and the breadth of its vision, is itself a great cause of hope. The NHS remains committed to a thorough reboot shifting its centre of gravity away from acute hospitals towards much stronger community and primary care (and indeed care delivered online).

A great deal depends on the 44 Sustainability and Transformation Plans (STPs) being drawn up across England to deliver the Five Year Forward View. As recent Reform research showed, STPs have successfully led to new conversations between the different parts of the NHS and between the NHS and local authorities. They are taking forward existing plans to reshape services. The remaining question, for the first panel of this conference to discuss, is how to help STPs deliver the scale of reform envisaged in the Five Year Forward View before the end of this Parliament. That debate should include ideas to give STPs more executive power, even to the extent of giving them democratic legitimacy through elections.

The Forward View rightly argued that prevention should be at the heart of the new NHS. The second panel will present ideas on the one of the most important contributions to prevention, via greater efforts by employers to promote the wellness of their own staff. Employees would benefit, together with employers (through
greater productivity), together with taxpayers. The NHS can lead the way in this respect because it is the UK’s biggest employer by far. A matter for discussion is how Government can support greater employee and employer activity.

The Forward View spoke of “financial incentives”, which could suggest tax relief to encourage employers. Such a programme may need, however, to avoid the “deadweight” cost of supporting employers who are providing for their staff already. Value for money lies at the heart of the reform agenda. The Service remains committed to £22 billion of annual efficiency gains, to be achieved by 2020-21. Lord Carter of Coles has done so much to promote thinking on efficiency and I am delighted that we can engage with him on our final panel.

Some have called on the Government to supply emergency funds in the forthcoming Budget, but there is little reason to think such an idea will make a lasting difference. George Osborne provided emergency funds twice, in 2014 and again the following year. For the second of those, the Chancellor front-loaded the NHS spending increases for this Parliament, so that it received £3.8 billion extra in the current financial year. That very big increase did nothing to prevent the problems that have dominated the headlines at the start of this year.

The current Government is right to stick to its reform plan. Today’s conference aims to help it deliver.