NHS 50
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The Debate for Our Future
The Debate for Our Future

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Futures Arena

The Debate for Our Future
NHS Voices
Madingley Scenarios
Citizens Voices
An International Voice
Our Shared Agenda
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NHS Voices
Madingley Scenarios
Citizens Voices
An International Voice

'Future Challenges for Health Care'

Introducing 'An International Voice' and how to have your say.

Donald Light, Professor of comparative health care systems, based at the University of Pennsylvania in USA.

British studies consistently show a high level of support and satisfaction with the NHS, but a comparative survey done at Harvard University found that more Brits than any other nation apart from Americans said that fundamental change was needed in their system. Is it worth spending more to change the problems of the NHS, or should that money go to education, employment or housing?

Future challenges arising from past decisions include:

  • GPs dropping sicker patients from their lists and referring on problems to cut costs.
  • GPs are protected by an independent contract. Yet experience shows that two thirds of primary care work can be done by less expensive nurses. Which GP functions do make economic sense?
  • Are managers and ministers ready to step on some big toes to move away from uneconomical traditional district general hospitals?

Fears that over the next generation health and welfare costs will rise due to an ageing population are not founded. From an international perspective, British costs are the lowest in Northern Europe and the ratio of working age people to elderly people will decline less than in any other country except Norway.

Rising expectations and demand suggest that the NHS needs a new social contract with its customers. What should be its terms?

A prominent American group of research and policy leaders have concluded that 70 per cent of diseases and disorders can be prevented or postponed, saving billions in acute services. But in the NHS, successful prevention is just an added cost, so how can that vision be realised?

User participation and a new commitment to patient involvement and openness is needed. For a democratic country, the NHS is surprisingly hierarchical and autocratic.

The Nuffield Trust recently demonstrated that NHS staff have higher sickness rates than the general public. How will the NHS recruit and train a growing workforce when the conditions and pay are becoming less attractive?

Even an optomistic realistic has good reasons to believe the gap between services and funding will widen. Should the NHS therefore narrow its services to emergency and acute interventions? Should health care go private? Should there be a supplementary health care tax or a voluntary contributory scheme? I think there is a case for all three - give us your views at the conference.

'Join the Debate'

Please take the time to fill in a questionnaire on this strand of the Debate for Our Future.

You can also register your overall personal view of what you think the NHS needs to do to ensure it thrives.

Read the full text before joining the debate.

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Future Challenges for Health Care

What do you think about these challenges to the NHS for the 21st century?


Is it worth an extra one percent of GDP to solve the problems? Or would it be better to spend it on education, employment or housing?

Challenges to Primary Care

Are British policy makers uninformed about the risk de-selection and cost shifting are taking place in some primary care practices?

The Future of General Practice

What will be the functions of the general practitioner that make economic sense?

Challenges to Hospital Care

The big savings lie in reconfiguring speciailty services to minimise hospital admissions and length of stay; but that implies stepping on some big toes. Are managers and ministers ready to do that?

What steps can be taken to move the information agenda forward?

How can the value of management be improved?

What kind of balance between centralisation, delegation, and devolution do we want to see develop?

The Challenge of Rising Demand

Will the information revolution and the internet help? What should be done to develop and steer it?

What steps should be taken to empower patients more?

What should the terms of a new social contract be?

Making The NHS Into A Real Health Service

How might that vision be best realised?

The Future Of Governance

  • How should the public be involved in setting standards and making policies?
  • What procedural rights should be established to frame and protect that involvement?
  • How should basic principles and priorities be set?
  • What substantive rights should patients have to health care?

Challenges Of Recruitment, Training And Retention

  • How much of the problem is level of pay?
  • How much of it has to do with career ladders with only two or three rungs?
  • What role do you think working conditions play?

What really needs to be done?

Limit the NHS to just Emergency and Acute Services?

Does this sobering evidence of a widening gap between funding and a good comprehensive service mean that the NHS should - or will have to - narrow its services to emergency and acute interventions?

Is compassionate care a priority or more of a luxury you think is not worth the extra cost?

Go Private?

Shouldn't the UK lay down fair rules for private markets?

A Supplementary Health Care Tax?

A Voluntary Contributory Scheme?

Get new equitable sources of funding started and see how each unfolds?

Other challenges

Are there other challenges that you think are important that have not been mentioned?

What do your colleagues think? Come to Earls Court July 1-3 and find out. Join the interactive 50th celebrations!

Please contact us if you have any queries or would like further information: future.issues.nhs@dial.pipex.com

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