The issue of health service planning regularly hits the headlines. In a speech delivered in October by the Chief Executive of NHS England, Simon Stevens described a “mismatch between resources and patient needs of nearly £30 billion a year by 2020/21”.
The issue of health service planning regularly hits the headlines. In a speech delivered in October by the Chief Executive of NHS England, Simon Stevens described a “mismatch between resources and patient needs of nearly £30 billion a year by 2020/21” [1]. Year on year increases in healthcare spending is often attributed to: demographic changes (an ageing population gives us more to do); advancing technology (we are able to do more), and; increased expectations (people demand more). However, in a recent OHE lunchtime seminar, Stephen Birch argued that these are in fact not the key factors driving the perceived unaffordability of healthcare, but rather that poor planning is responsible. To promote sustainability, spending should be better linked with needs.
Public healthcare systems, such as those operating in the UK and Canada, are created in response to market failure in healthcare and the belief that access to health should be based on need rather than willingness or ability to pay. The forces described above as placing upward pressures on spending are not equivalent to the increased needs of the population. Whilst consideration of needs has been integrated into the way decisions are made around distributing the healthcare spending (i.e. through resource allocation formulae), such considerations do not feature in budget setting – i.e. deciding on the size of the cake.
Stephen Birch attributes spending rises to the influence of the suppliers of healthcare on the levels and mix of services that are provided, and that are unrelated to levels of health care needs in the population. In a paper published in the Journal of Health Services Research & Policy [2], Birch and colleagues argue that planning on the basis of a fixed production function is inappropriate, and the authors offer an alternative framework. By highlighting the necessarily dynamic and interacting nature of the key factors that should influence planning, Birch argued that there is nothing inherently unsustainable in publicly provided healthcare, but that there must be a re-focus on population needs, rather than provider interests, in planning models. Additionally, the policy space must be broadened.
The OHE lunchtime seminar was attended by members of academia, industry, clinicians and government, and the lively discussion reflected the importance and timeliness of needs-based planning. An OHE briefing will be published in due course providing further detail.
[2] Birch S, Mason T, Sutton M, Whittaker W. Not enough doctors or not enough needs? Refocusing health workforce planning from providers and services to populations and needs. Journal of Health Services Research & Policy 2013 Apr 1;18(2):107-13
