Costing the NHS Costing the NHS - live page

18 Sep 2013 Last updated at 21:13

Costing the NHS

Can we maintain the NHS as it is or do we need to envisage big changes? Julian Worricker hosted a two-hour debate on Monday 16 September.
  • 17 Sep 2013 15:46:19

    Listen to the programme:

  • 16 Sep 2013 21:45:09

    Sir David Nicholson - chief executive of NHS England

    NHS England warned in a recent report that by 2020-21 the gap between the budget and rising costs could reach £30bn. 

    However, the chief executive of NHS England, Sir David Nicholson, says 'there will be no blanket bans’ on current NHS services:

    BBC Radio 4
    Sir David Nicholson of NHS England: 'the fairest way I've seen of getting money into a health system is through general taxation' #r4nhs
    Judith Smith
    David Nicholson rejects copayments for at least the medium term and says general taxation is fairest way of funding the NHS #r4nhs
    Kamal Latif
    #r4nhs I was glad he made the point that just because an organisation is private doesn't mean it's more efficiently run, that's an ideology
    NHA Party
    NHA Party @NHAparty tweeted:
    Sir David Nicholson says if private sector can deliver better and higher quality service then should use it. #r4nhs
    Save St Helier!
    Nicholson uses example of tattoo removal as a "non-core service". Is this so people think it's OK to cut all "non-core services"? #r4nhs
    Richard Blogger
    Stopping tattoo removal on NHS will save tiny amounts of money compared to the entire budget #r4nhs
    diana smith
    #r4nhs The programme concluded with the idea that clinicians have to do more to make the case for change, which must be evidence based.
    We need to increase public involvement at all levels of health and social care, from local participation all the way up to the board of NHS England. (Titus Alexander)

    Roger Davidson
    #r4NHS debate - the panel - Nicholson, Dorrell et al - in the studio preparing for the final section
  • 16 Sep 2013 21:04:47

    Controversial proposals for change

    In the next part of the programme we’ll hear three suggestions for what are regarded in some quarters as radical changes: patients paying for some services, an increased role for the private sector and the closure of local services to create centres of excellence. A panel of experts will then examine the cases being made.

    Julian’s panel:

    Dr Clare Gerada, chair of the Royal College of GPs.

    Anita Charlesworth, chief economist at the Nuffield Trust.

    Chris Hopson, chief executive of the Foundation Trust Network

    Stephen Dorrell MP, chair of the Health Select Committee and former health secretary.

    1. Tax-funded core services with top-up payments for additional care.

    In the telephone poll for this programme, we asked 1000 people across the UK if they would be happy to pay for a visit to the GP - around three quarters said no. Around half said patients should pay for some of the non-emergency care currently available on the NHS.

    Christoph Lees is an obstetrician and he is founder of the Doctors Policy Research Group linked to the independent think tank Civitas. He puts the case for patient contributions.

    Civitas think tank
    Many aspects of NHS care are already not free at point of use, Christoph Lees points out #r4nhs
    Christina McAnea
    #r4nhs difficult to follow civitas arguments for NI systems and top ups. Must lead to 2tier system

    2.  Increasing the involvement of the private sector.

    Our opinion poll tested feeling on the private sector’s role in the NHS, asking 1000 people across the UK whether competition from private companies to provide NHS services will improve care.  About a third agreed, while half disagreed.

    Andrew Haldenby is director of the centre-right think tank Reform, which focuses on public services. He puts the case for private sector involvement.

    John Grumble
    From what I've seen of private train companies, private utilities and private banks I fear for a privatised NHS. #r4nhs
    People in the UK are very blinkered. Private provision of state funded healthcare is a taboo here. It isn’t in some very left-wing countries. And the German example shows you that private provision doesn’t cut quality to increase profits, instead it increases profits to improve quality. (Dr. Eric Woehrling)

    Inkwell Arts
    Whatever your opinions on the use of private sector to extend capacity, the use of the word "customer" is a radical shift #r4nhs

    3. Closing local services to create centres of excellence.

    One proposal for changing the way that the NHS is structured is to adopt the ‘fewer bigger better’ model. This has already happened to stroke centres in London. There are now eight super centres in the capital; there used to be 30. It’s estimated that that reorganisation will save 400 lives a year.

    Catherine Carr went to meet Surgeon Giles Peek at work at the Congenital Heart Centre at Glenfield Hospital in Leicester, along with two of the people who campaigned to keep it open when it was threatened with closure. Listen to her report:

    BBC Radio 4
    Accessibility of hospital services can be more important to patients than excellence of care, our @Leic_hospital report suggests #r4nhs
    We shouldn't be just going for bigger and better, says Stephen Dorrell MP
    I entirely support the move to specialised units. When my granddaughter had a serious fall at a weekend, the choice was between my local general hospital (where I had been an non-executive director) and a regional trauma centre. I chose the latter. When we arrived by ambulance there was a team of 20 trauma specialists waiting for us and she was dealt with rapidly and with a positive outcome. My local hospital would have had junior docs, some registrars and a consultant at the end of the phone. We need more specialised centres!
  • 16 Sep 2013 20:52:32

    Efficiency savings

    What else should the NHS should be looking at if it needs to cut costs? Karen Taylor was, until 2011, the long-standing director of health value for money at the National Audit Office and is now research director at the Deloitte UK Centre for Health Solutions.

    We need to address the way patients waste NHS resources. Learning about taking responsibility for our own health to reduce incidence of chronic disease needs to be included as part of the national curriculum from pre-school. Patients need to turn up to clinic appointments if they want to see improved services and reduced  waiting times. (Nicole)
    My husband died on the 18th August.  Over the last 20 months I have witnessed a staggering degree of waste of resources in the NHS, much as a result of poorly coordinated services. (Sally)


  • 16 Sep 2013 20:45:23

    New medicines and technology

    How much can the costs of new drugs and research into medical advances be pared back if savings in the NHS budget need to be made? Andrew Dillon is chief executive of NICE which provides guidance on medicines and technology that aims to ensure quality and value for money, primarily for England, but also to different degrees for all UK NHS services.

    Matt Hare-Scott
    Andrew Dillon throwing the gauntlet down for pharma to show the value of their products. Isn't that what NICE do? #r4nhs
    Simon Eaton
    #r4nhs millions spent (wasted) on drugs approved by NICE, but same effect or marginal benefit and 10x cost. Must consider affordability
    Let the NHS design treatments and drugs and then manufacture and sell them in every part of the world. The NHS is a trusted brand because it is not driven solely by the profit margin. This can more than pay for the NHS. (Leon)
    I am a 45 year old single woman who has never had opportunity to have my own children. But I still totally disagree that women should receive such treatment through the NHS. It may be painful not to be able to conceive naturally,  but life is not fair and we are faced with people dying because they are denied life saving treatment. (Beverley)

  • 16 Sep 2013 20:46:47

    Integrating social and health care

    The integration of health and social care in England has been described as ‘the Holy Grail’ of health policy and ‘historic’ by none other than Chancellor George Osborne. 

    There is widespread support for the policy but less clarity about how much such a change will cost, and how much money it might save. 

    The government has committed £3.8bn to an integrated care fund, but £3bn of that comes from the Department of Health and the other £800m from the Department of Communities and Local Government. Meanwhile the Association of Directors of Adult Social Services fear they might lose another £800m from their £16bn budget this year. Sandie Keene is the President of that Association, representing all the directors of adult social services in England as well as senior managers who report to them.
    Varsha Dodhia
    Health and Social Care budgets are like caviar and potatoes, highly prized and poor cousin integration now imperative staff upscalng #r4nhs
    PJ Bowyer
    PJ Bowyer @NHS_GP tweeted:
    Integration between primary and secondary care so important yet so absent. #r4nhs
    Catherine Max
    #r4nhs good for @SandieKeene, first to talk about end user contribution to solutions #PPI
    I see many situations where GPs admit frail elderly patients into acute hospitals when they could be kept at home or
    within nursing homes. These patients will often die as 'anonymous' in-patients instead of where they live and are more cared for. Elderly people often end up staying in hospital for too long without a clear of realistic plan of care. (Fiona)
    FTN @FTNtweets tweeted:
    Integration is not a necessarily a money-saving exercise, but will add value and resources will be used appropriately #r4nhs
    BBC Radio 4
    'NHS services are delivered free at point of need. Many social services are not': @cmcanea asks how, in practice, we integrate them #r4nhs
    Karen Lynas
    #r4nhs impact of social services reductions really important to consider with NHS funding
    Integration and competition are incompatible, says this diabetic using 5 different NHS services (Alex Scott-Samuel) 

  • 16 Sep 2013 20:28:36

    Surgical Cuts - listen online

    Here's the programme Julian mentioned:
  • 16 Sep 2013 20:33:10

    Working with the current funding system

    Tony Whitfield is the director of finance and deputy chief executive of Salford Royal NHS Foundation Trust, and currently the president of the Healthcare Financial Management Association. Salford was the one-time recipient of zero stars in the Healthcare Commission’s rating system, but is now – according to a range of key measures – one of the best performing trusts in England.

    Protect Our NHS
    Salford NHS Trust good example how NHS can transform itself in difficult times>real engagement with staff @BBCRadio4 #costingtheNHS #r4nhs
  • 16 Sep 2013 20:32:44

    Perspectives on current funding levels

    Stephen Dorrell MP is chair of the commons Health Select Committee and, in the last two years of John Major’s government, secretary of state for health.

    BBC Radio 4
    Stephen Dorrell MP on Costing the NHS now: how can we deliver an NHS which works to prevent illness as much as cure it? #r4nhs
    NHA Party
    NHA Party @NHAparty tweeted:
    Former Tory Health Sec Stephen Dorrell says we need better care before people are acutely ill - prevention and early intervention. #r4nhs
    Ram Moorthy
    #r4nhs- prevention good aspiration but in short term (5 years) will be to deal with health inequalities here and now
    Dr Mark Porter is chair of the ruling council of the British Medical Association which has 140,000 doctors as members across the UK. 

    "There are going to be hard choices about what's available on the NHS and we believe the government's ducking those choices, " he says.

    Don Redding is director of policy of National Voices, a coalition of health and social care charities in the UK. He wants people to 'take more charge of their health'.

    Thomas Cawston
    Don Redding from @NVTweeting talking good sense on @onradio4now #r4nhs need transformation and engage patients in care. Hero of first 15mins
    Christina McAnea, is head of health at UNISON, which has 450,000 members in the health service in the UK. 

    She says: 'We've already wasted two years in a completely unnecessary reorganisation of the NHS'.

  • 16 Sep 2013 20:06:35

    Is there a funding gap and if so, how big is it really?

    Prof John Appleby is chief economist at the Kings Fund, a charity that carries out analysis of the health service with improvement in mind.  
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