Comment / Horizon scanning

On 5 July 2018 the NHS will be 70 years old. While there is much to celebrate in this anniversary, it also prompts us to think about the future of health and care – can the NHS reach its 100^th birthday in its current form? The HFMA is considering this question, and the challenges the system will face over the next 30 years, in a series of roundtables. 

In 1979, a Royal Commission on the NHS reported concerns about the cost of an ageing population and technological developments. Nearly 40 years on, these are still two of the primary concerns for the service and the strategy for the next 30 years needs to consider how to address these areas in a sustainable manner.

Demographic change is the focus for the first of the roundtables.  By 2048, the UK population is expected to have increased by 8.7 million people.  With the system struggling to meet the current demand, the focus must change to tackling the causes of, and preventing, ill health. Public Health England has highlighted that 55% of the determinants of ill health are due to social and behavioural factors. So how can the NHS support and incentivise healthier behaviours and impact the wider social issues affecting demand?  Quantifying the financial savings of prevention can be a challenge, so how can finance teams support this development?

Ageing, and the associated conditions, will continue to be a challenge for the NHS and social care. By 2048 the number of people over the age of 85 will have more than doubled from current levels. It is anticipated that around 70% of this age group will have at least one long term condition and the associated demand for services varies significantly across the country. To develop a sustainable NHS for 2048, addressing health inequalities will be essential.

When considering the social determinants of health, there is a question around the role of the state and what should be expected of the individual. Another of the roundtables will discuss where state actions, such as the smoking ban, could be usefully deployed and where the emphasis should be placed more on local communities.  How do place-based approaches fit into a national quality regime? And the need for financial flexibility to enable local public services to work effectively together will also be debated.

Technological developments were a concern in the 1970s, but the speed at which things have changed could not have been anticipated at that time. Understanding, and optimising, developing technologies will be essential for the NHS of the future and will be discussed at a roundtable focusing on the impact of technology.

Delivering care will change dramatically as personalised medicine becomes common place through the development of genomics. Treatment will be tailored to the individual enabling it to be more effective. However, pathways, contracts and costing are currently based on standardisation, so how will the NHS need to adapt to accommodate this new treatment approach?

The data generated over the next 30 years through the use of technology and the increased understanding of genetic profiles, will be incredibly powerful. However linking lifestyle factors with genetic profiles, and combining this with more traditional clinical data, will require processing power and storage capacity beyond that currently in common use in the NHS. To maximise the benefit of this interconnected data, a workforce highly skilled in analytics will be essential.

The final roundtable will draw together the themes from the first three and consider the implications for the finance department. Technology will play a significant role as transactional finance tasks become more automated, with greater assurance of accuracy. Central reporting regimes will need to change to enable individual organisations to maximise technology and reduce the need for manual checks.

The finance staff of the future may need very different skills to those that they are currently trained in. Key among these skills will be to not only analyse and interpret large quantities of data, but to understand the implications of the results for the future business and service development. We will be joined by the accountancy bodies to consider whether we are training our staff for the future and what new skills should become commonplace.

If you would be interested in participating in these discussions, and contributing to the HFMA’s NHS at 100 briefing, please contact HFMA head of policy and research [email protected]

A briefing summarising the roundtable discussions will be launched at the Convergence 2 conference on 5-6 July. Click here for more information and to book your place.