robert hill consulting what does the future hold? and how can nurse leaders influence it?
TRANSCRIPT
Robert Hill Consulting
The big picture on spending Government plans to halve the deficit over 4
years by 2013/14
Action to do this covers three areas:
– Growing the economy to increase tax revenues
– Raising taxes - £19 billion
– Cutting spending - £38 billion (around £20 billion of this sum has been identified and the rest hasn’t as yet)
Robert Hill Consulting
Some DELs to be protected… Overseas Aid
– Meet 2013 target of spending 0.7% of Gross National Income
Health
– Real freeze in ‘front-line’ spending
Education
– 0.7% real increase in ‘front-line’ schools spending
– 0.9% real increase in ‘front-line’ spending on 16-19 participation
– Real freeze in ‘front-line’ spending on Sure Start
Robert Hill Consulting
Cuts announced to date
1% cap on public-sector pay to reduce spending by £3.4bn
Cuts to lower value spending programmes worth £5bn
Cap on employer-pension contributions saves £1bn
Efficiency savings of £11bn
– Some of which have been achieved but some not
– Ambitious future targets
Robert Hill Consulting
Health has to generate the highest efficiency savings in cash terms…
£ billion
Source: IFS
Robert Hill Consulting
There is more to come Another of £18 or so billion of cuts to be specified
Conservatives would start sooner (this financial year) and cut deeper
– But give the NHS real term savings
– But cut NHS administration by a third
– And stop the forced closure of A&E and maternity units
Scotland, Wales and Northern Ireland will proportionately be affected in the same way
– They will have discretion as to apportion the cuts
Robert Hill Consulting
Funding is not the only challenge facing the NHS… More choice and power for patients
– Guarantees and choice of provider
– Personal health budgets (integrated with social care)
Diversity of provider organisations and greater competition between them
Commissioning based on pathways of care– More care closer to home
– Polysystems
Increased co-payment– Reform of social care
Continuing workforce reform
Robert Hill Consulting
…there are other challenges as well Rising and ageing population
– Increasing life expectancy
Growing diversity
New drugs and treatments
Digital revolution
Public health
– Rising obesity
– Great emphasis on prevention
– Continuing inequalities on society
Robert Hill Consulting
The response locally… Have a medium term plan
– Be strategic don’t go for incremental cuts year by year
– Use process re-engineering to look at things from first principles
Be clear about priorities
Act with partners – Total Place
Use opportunity provided by creation of arms length provider units for community services
– Social enterprises
Communicate with staff continually and engage them in change
Robert Hill Consulting
…and nationally
Freedom of information evidence
Parliamentary questions and
debates
Select Committee reports
Media reports and campaigns
Petitions, letters and surveys
Legal challenges
VisitsWell-evidenced
reportsOrganisational
muscle
Robert Hill Consulting
Board level discussions and plans
Responses to public consultations
Freedom of information requests
Demonstrations of replicable innovative practice
Policy studies backed by action research
Conduct surveys and publish results
Getting alongside key opinion formers
– Talk to SHA, Visits, Chatham House rules events
Using MP visits and discussions
RCN position and discussion papers
Key levers that nurse leaders can use