Finances, targets, and workforce are on NHS agenda for next parliament, hears meeting

BMJ 2015; 350 doi: (Published 21 May 2015) Cite this as: BMJ 2015;350:h2804
  1. Zosia Kmietowicz
  1. 1The BMJ

Tackling the black hole in the NHS’s finances, relaxing targets, and building an NHS workforce to meet the needs of the population are likely to feature strongly in discussions concerning the NHS in the next few years, participants at a debate on the priorities in the coming parliament have heard.

However, a major NHS reorganisation is unlikely, and competition in the NHS seems to be taking a backseat, heard doctors, commissioners, policy makers, and managers at the debate organised by the health think tank the King’s Fund on Thursday 21 May.

That Jeremy Hunt has been reappointed as health secretary for England will provide continuity for the NHS, said Saffron Cordery, director of policy and strategy at NHS Providers, the membership organisation for public providers of NHS services. And with the prospect of no major legislative changes for the NHS in the Queen’s speech on 27 May, the next few years should provide a time for Hunt to “listen and understand the NHS frontline,” said Cordery.

She said that there was an urgent need “to calm down the febrile financial situation,” to set out a realistic future funding plan, a realistic direction for the workforce, and to discuss pay and conditions.

An analysis by the King’s Fund in April found that hospitals and other NHS providers in England were set to post a record deficit of more than £800m (€1.1bn; $1.2bn) in 2014-15.1 Furthermore, to maintain services, savings of more than £22bn a year would be needed by 2020-21, even if the NHS were to get the £8bn a year in extra funding by this date promised by the Conservatives before the election.2

Facing this financial challenge was described as “paramount” by Sarah Wollaston, a former GP in Dartmoor and the Conservative MP for Totnes, also a speaker at the meeting. Wollaston emphasised the need to diversify the workforce and use the skills of pharmacists, nursing assistants, and healthcare assistants to help deliver the level of efficiency savings that have been estimated were needed.

She spoke out against the government’s plan to expand hospital and GP services to seven days a week.3 The whole premise of seven day working was to reduce death rates in hospitals at weekends to the level seen on weekdays, said Wollaston, and to “prioritise convenience” by making general practices open seven days a week where there was no demand and no capacity would take away resources from somewhere else.

Nick Timmins, former public policy editor at the Financial Times and a researcher at the King’s Fund, predicted that there would be “a major shift in competition” over the next few years, with a move away from the belief that marketisation was a solution to the pressure on the NHS. Referring to the plan to devolve responsibility for health and social care to statutory organisations in Greater Manchester,4 he said that “Devo Manc was about building more cooperation not more competition.”

Speaking from the audience, Bill Morgan, a former special adviser to the previous health secretary, Andrew Lansley, and a founding partner of the health consultancy Incisive Health, predicted that the NHS was about “to witness an unprecedented degree of centralisation,” especially on the costs of agency staff, which the government wished to curb. He also believed that the model of foundation trusts was “vulnerable” and that to control costs “repealing the model will be quite attractive.”

Timmins agreed that “when you reach the stage that lots of foundation trusts are struggling” then people started to question the premise behind them. He said that it was unlikely that there would be new legislation to change the status of foundation trusts, but he added that “you can change behaviour without that.”

All panellists agreed that targets would be scrutinised in the coming months and perhaps lowered to ease pressure on the NHS, with the public being given more realistic expectations of what the service could deliver.

Chris Ham, chief executive of the King’s Fund, who chaired the meeting, concluded by asking the question, “What kind of targets might be evolved from now to more accurately represent what the service is trying to do, and how we can best meet the needs of patients and users without sacrificing the improvements in care we have seen in the last 15 years?”


Cite this as: BMJ 2015;350:h2804


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