Health: local needs and national priorities

11th Jul, 2014

The UK faces two seismic challenges in the next decade and beyond: how to cope with an ageing society while dealing with tightly constrained national spending budgets.

This isn’t a problem unique to the UK but one shared to greater or lesser extent by most advanced nations whose successes in the second half the 20th Century – leading to the healthiest and longest living generation ever – have been matched by the economic failure and subsequent public spending cuts since 2008. As it stands, we face rapidly increasing numbers of older people (those who require the greatest amount of care) at a time when the NHS budget is frozen.

The data presents a particularly stark picture – in 2015 there will be 3.2m people aged over 80 in the UK but by 2030 there will 5.3m.

The implications of these twin challenges were explored at length in the Shape of Training Review, published last October (to which Trajectory contributed scenarios and forecasts) which examined what pressures doctors would be dealing with in a few decades time. While technological advances such as genomics and predictive diagnostics can lead to greater efficiencies, the most urgent need is for a restructuring of the delivery of healthcare. The direction of travel envisioned by many doctors is away from regional or district hospitals and towards community care.

The first steps towards this vision were announced this week when Simon Stevens, NHS England’s chief executive, announced that billions of pounds of health and local council budgets will be controlled by individual patients, allowing them to select their health and social care services in their own community. The move is an attempt to balance the urgent (and doctor-demanded) need for community based local care with the perennial consumer demands for choice and control.

The desire to have greater control over our health is a prominent consumer trend (as explored in a recent Trends Breakfast, self-quantification is driving technological advance) but greater choice does not necessarily lead to greater control. In terms of health – especially for those with the most urgent of specific needs – we are likely to defer to the knowledge and experience of professionals (one reason why doctors consistently come out high in trust surveys).

Although the move towards community based care is likely to be welcomed by many (doctors and patients alike) the shift to allow the patient to curate and manage their health services is part of the broader trends in the deregulation of life and the transference of risk. This trend is also reflected in the recent pension reforms. Elsewhere, we have explored the rise of the ‘Compromised Consumer’ – those beset by time, money, and control pressures – which is likely to include many of those requiring health and social care on an ongoing basis.

These concerns will have to be balanced against the urgent need to reshape the medical landscape and the location of health and care in the UK in a period of deep spending constraints. Only one thing is certain: the health demands of the UK population will only intensify in the future.