Robert Hill Consulting What does the future hold? And how can nurse leaders influence it?

Robert Hill Consulting

What does the future hold?

And how can nurse leaders influence it?


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)


Public spending 2011/12 – 2014/15

Source: IFS


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


…which means less for other departments

Source: IFS


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


Health has to generate the highest efficiency savings in cash terms…

£ billion

Source: IFS


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


…but not in percentage termsPercentage of DEL

Source: IFS


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


…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


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


…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


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

Documents

Robert Hill Consulting What does the future hold? And how can nurse leaders influence it?