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    Understanding what it all means

    The NHS began on the ‘Appointed Day’ of 5 July 1948, with the explicit goal of “comprehensive health and rehabilitation services for prevention and cure of disease”. This was, in part, due to a growing optimism surrounding science and a renewed faith in the democratic principles of the Western World against the cold and authoritarian approach of Soviet Union.

    Nearly sixty years later, the world is a changed place. Rather than focusing on delivering care to patients with acute needs, as was described in the original plan, the NHS is now responsible for a far more expansive and diverse remit. As such, many of the care services are delivered as outpatient services.

    This has led to the need to properly manage outpatient facilities and ensure standards across a far larger cross-section of the country. No longer are requirements localised to hospitals, now they encompass all types of care facilities. The organisation who represent this change most powerfully, managing regulations across healthcare facilities, are the CQC – the Care Quality Commission.

    General NHS statistics in 2016

    • NHS net expenditure (resource plus capital, minus depreciation) has increased from £75.822 billion in 2005/06 to £117.229 billion in 2015/16. Planned expenditure for 2016/17 is £120.611bn.
    • In real terms the budget is expected to increase from £117.229bn in 2015/16 to £120.151bn by 2019/20.
    • Health expenditure (medical services, health research, central and other health services) per capita in England has risen from £1,868 in 2010/11 to £2,057 in 2014/15.
    • The NHS net deficit for the 2015/16 financial year was £1.851 billion (£599m underspend by commissioners and a £2.45bn deficit for trusts and foundation trusts).
    • The most recently published national surveys of investment for mental health found there had been real terms reductions of 1 % for working age adults and 3.1 % for older people in 2011/12.


    The Role of the CQC

    Today, the vast majority of healthcare services are focused around outpatient care. The demographic of primary patients has also changed. The common patients who use NHS services today tend to be older with chronic conditions rather than acute, short-term, diseases. This means they have longer-term needs which cannot be properly managed without the right environment.

    The CQC actively regulate three areas:

    1. Treatment, care and support provided by hospitals, GPs dentists, ambulances and mental health services.
    2. Treatment, care and support services for adults in care homes and in people’s own homes (both personal and nursing care).
    3. Services for people whose rights are restricted under the Mental Health Act.

    This is something which has been well managed at a patient level, but is not something generally considered outside of the health industry. The CQC exists to define good practices to deliver high levels of care. As a secondary role, they also have a responsibility to provide education to local communities and home carers – giving them the foundation to make long-term conditions manageable and create environments which actively improve patient outcomes.

    Doing this effectively means understanding what is ahead; looking at trends and defining better psychological approaches to managing outpatient care. With its vast level of responsibility however, it may be the case that this final step is simply not possible – that in many cases the CQC is unable to properly support people outside of the NHS care system.

    The challenges faced by the CQC in 2017 and onwards.

    • The NHS deals with over 1 Million patients every 36 hours.
      • Life expectancy for English men in 2013-15: 79.4 years.
      • Life expectancy for English women in 2013-15: 83.1 years
    • The UK population is projected to increase from an estimated 64.6 million in mid-2014 to 69.0 million by 2024 and 72.7 million by 2034.
    • The UK population is expected to continue ageing, with the average age rising from 40.0 in 2014 to 42.9 by 2039.
      • The number of people aged 60 and over is projected to increase from 14.9m in 2014 to 21.9m by 2039. As part of this growth, the number of over-85s is estimated to more than double from 1.5 million in 2014 to 3.6 million by 2039.


    Helping the NHS manage costs


    One of the greatest challenges facing the NHS and the CQC are not introducing processes or managing regulations, but rather agreeing and communicating required changes to the way the UK health market works, in the name of improving patient care.

    It will also face the challenge of reducing the deficit caused by a health service which has been stretched so thin among a large number of smaller institutions. This point has been made very clear more recently following a revealing Commons Select Committee spending review in July 2016 and the multiple Young Doctor’s strikes which have had the explicit aim of increasing public awareness that the NHS services need to change and evolve to meet new demands.

    Committee Chair Dr Sarah Wollaston MP said:

    “Whilst the NHS has been treated favourably compared to many other departments, the increase in health funding is less than was promised if assessed by the usual definitions.

    Funding cuts to public health will make it more difficult to address the challenge set out by the Prime Minister to reduce health inequality.

    The cuts to public health undermine the radical upgrade to prevention that is needed to keep people healthy, reduce the gap in life expectancy and years lived in poor health for the most disadvantaged, and reduce demand on the health service. Cutting public health is a false economy, creating avoidable additional costs in the future.

    Similarly, the cuts to health education come at a time when the workforce shortfall is already placing a significant strain on services and driving higher agency costs. Training and developing the current and future NHS workforce must be a key priority for the NHS and we are deeply concerned about the effect of cuts to training budgets.

    We welcomed the upfront funding which was designed to pump prime the transformation of services. But sustainability and transformation funds are being used almost entirely to plug provider deficits, rather than to resource essential changes to the health and social care system at scale and pace.

    Short-term measures are being used to deal with the worsening financial situation. Capital budgets have been raided to meet current spending and trusts encouraged to ‘review their accounting estimates for savings’. We are concerned that these measures are masking the true scale of the underlying financial problems facing the NHS.”

    The NHS vs the rest of the world:

    • Current health expenditure in the UK was 9.78 % of GDP in 2015. This compares to 16.91 % in the USA, 11.08 % in Germany, 11.01 % in France, 10.76 % in the Netherlands, 10.59 % in Denmark, 10.16 % in Canada, 9.05 % in Italy and 9.00 % in Spain.
    • Current expenditure per capita (using the purchasing power parity) for the UK was $4,015 in 2015. This can be compared to $9,451 in the USA, $5,343 in the Netherlands, $5,267 in Germany, $4,943 in Denmark, $4,614 in Canada, $4,415 in France, $3,272 in Italy and $3,153 in Spain.
    • The UK had 2.8 physicians per 1,000 people in 2015, compared to 4.1 in Germany (2014), 3.9 in Italy (2014), 3.8 in Spain (2014), 3.5 in Australia (2014), 3.4 in France, 3.0 in New Zealand and 2.6 in Canada (2014).
    • The UK had 2.7 hospital beds per 1,000 people in 2014, compared to 8.2 in Germany, 6.2 in France, 3.0 in Spain, 2.8 in New Zealand and 2.7 in Denmark.
    • The NHS net deficit for the 2015/16 financial year was £1.851 billion (£599m underspend by commissioners and a £2.45bn deficit for trusts and foundation trusts).
    • The most recently published national surveys of investment for mental health found there had been real terms reductions of 1 % for working age adults and 3.1 % for older people in 2011/12.


    Making UK health great again!


    Firstly, there have been some fantastic advances made by the dedicated health professionals in the UK. Anyone who does not recognise the tireless efforts of those individuals does not truly appreciate the amount of love and passion that NHS employees have. Their enthusiasm and dedication can be found in no other health organisation in the world. Similarly, the willingness to want to improve through independent bodies such as the CQC are a truly positive step forwards in improving healthcare for the future.

    Much like the UK rail network though, it seems likely that at some point shouldering the full cost of all services will no longer be viable, and that private businesses must play a bigger role within the delivery of healthcare more broadly.

    That is not to say that the NHS will ever become privatised in the business sense, but rather there are some forms of technology and outsourcing which make sense to bring into the existing system. A good example may be ensuring patients are able to manage their health safely and more effectively with less direct involvement from doctors.

    Mobile Apps such as Medisafe, a free reminder tool for taking medication and tracking what medication has been taken over long periods of time, can actively improve the effectiveness of treatment and diagnosis, for instance. This is especially important to mitigate future concerns surrounding resistance to antibiotics.

    32996356 - health app connectivity concept: smart watch and touchscreen smartphone isolated on white background
    58% of Smartphone users have downloaded a fitness or health app. Source: Langone Medical center, USA.

    Another route forwards is a timeless idea which has significant real-world impact: that prevention is better than a cure. Technology designed to track biometric data and give real-time understanding of health are also another potential boon for the healthcare industry. If they can be pioneering in how to utilise this data effectively, it will remove the need for large, expensive scanning machines.

    Indeed, gaining new insights surrounding the biological conditions or psychological barriers that lead to sickness, then working to reduce those much wider impacting areas, may have a revolutionary effect. This has already been seen in a variety of areas through the ‘Behavioural Insights Team’ who work in partnership with the Cabinet Office.

    Rory Sutherland, a leading force in the world of Behavioural Economics, points out that if you had a finger-sized hole in the wall which was able to painlessly and rapidly check your health status, people would use it five times a day – where now they go to great lengths to avoid going to the doctor until treatment is absolutely necessary. Understanding that fear and time have a role to play is just another step in the journey to improving our understanding of how to solve national and international health concerns.

    The NHS: Dealing with increased pressure

    • In 2015/16 there were 40 % more operations (‘procedures and interventions’ as defined by Hospital Episode Statistics, excluding diagnostic testing) completed by the NHS compared to 2005/06, with an increase from 7.215m to 10.119m.
    • There were 16.252m total hospital admissions in 2015/16, 28 % more than a decade earlier (12.679m).
    • The total annual attendances at Accident & Emergency departments was 22.923m in 2015/16, 22% higher than a decade earlier (18.759m).
    • There were 1.836m people in contact with specialist mental health services in 2014/15. 103,840 (5.7 %) spent time in hospital.
    • There were 21.034m outpatient and community contacts arranged for mental health service users in 2014/15.


    How do Lexmar Direct assist the NHS?

    We are very proud to play a small part in ensuring the future of the NHS. Our specialist lock designs are the only products in the UK which are strong enough to actively halt any attempt to break them open. This ensures prescription paper is fully protected across the many NHS trust locations.

    Additionally our products are used in homes up and down the country, helping carers manage highly impacting mental conditions such as Dementia and Prader-willi syndrome, which can be a constant challenge.

    If you are part of an NHS trust or are looking for robust, indoor locks which feature colours that make them blend into the environment, we are able to supply your demand.