Chapter 32 - The Future of the NHS

This is a summary of chapter 32 - Alternative Funding Models. It was written by Dr Eamonn Butler, Director of the Adam Smith Institute, an influential think-tank which for more than twenty years has designed and promoted practical policies to promote choice and competition in the delivery of essential services. He frequently contributes articles to national magazines and newspapers on subjects such as health policy, economic management, taxation and public spending, transport, pensions, and e-government.

In this chapter he discusses the alternative methods of funding the NHS. Explaining that even after record big budget, the finances remain in a rough state, with many trusts reporting deficits and some being plainly unable to bring their budgets under control. The chapter argues a strong case for looking at alternatives for how the UK healthcare system should be funded. It offers an instructive overview with 16 other alternatives. To learn more about these 16 alternatives I would encourage you to buy the book, it can be bought from most good bookshops or on line at www.thefutureofthenhs.com

Chapter 31 - The Future of the NHS

This is a summary of chapter 31 - Taxation and Insurance. It was written by Professor Alan Maynard, Professor of Health Economics and Director of York Health Policy Group at York University. He has worked as a consultant for the WHO, the World Bank, the European Union and the UK’s Government Department for International Development. He is widely published in many books, specialist journals and the mainstream media. Since 1997 he has been Chairman of the York NHS Trust.

In this chapter he focuses on the debate about financing health care, remembering the objective of the NHS: to improve population health for the least cost. However, instead of focusing on the clinical and cost effectiveness of competing interventions and measuring clinical outcomes, the media and competing politicians propagate the illusion that more and/or different funding will “cure” the system’s often ill-defined problems.

The principle conclusions to be derived from his discussion of funding health care are that reasons for advocating change may be disguised by ideological and political agenda, but proponents of change have to be challenged. All health care systems, public and private, exhibit gross inefficiencies in terms of variations in practice and failure to deliver, but what the evidence base shows to cost effectiveness? The challenge for all who enter the debate about funding is to be transparent about their ideological concerns. Also, they must recognise that pouring more money into a health care system may not improve the level nor the distribution of population health.

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Chapter 30 - The Future of the NHS

This is a summary of chapter 30 - Financing the NHS: The Current System. It was written by Mr Tony Harrison, a Fellow in Health Policy at the King’s Fund. He has published extensively on the future of hospital care, the private finance initiative, health research policy and waiting list management.

In this chapter he gives an overview of the ways in which the NHS is financed and the historical loop funding seemed to have followed. He believes the decision to finance services almost entirely out of taxation, still leaves a large number of issues to be resolved. The question remains to be considered, is it appropriate to continue to rely upon tax finance? The Government is committed to it: so is the Conservative Opposition. Nevertheless, it may come into question in the very near future.

The Government’s response was to argue that tax finance remained the best option, but that substantially more resources would be needed to provide high standards of health care. The result was the largest sustained increase in NHS spending ever experienced. This rate of increased spending will continue until 2007, but what will happen after that?

He believes, as yet, there is no reason to believe that the level achieved will be regarded as ‘good enough’: the pressure to spend more will continue, due to new technology, the need to continue to raise clinical quality, and from the Government’s own desire to respond to what it perceives as rising public expectations.

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Chapter 29 - The Future of the NHS

This is a summary of chapter 29 - Redressing the compensation culture. It was written by Mr Tim Kevan, a Barrister at 1 Temple Gardens with expertise in personal injury (including clinical negligence), sports, consumer and general common law. He is the author of nine legal textbooks and edits three legal newsletters.

He Suggests that a culture of risk aversion and fear of litigation has gone too far. In order to re-set the balance, he suggests the following:
1) The law of liability for clinical negligence to be reviewed and that certain medical specialties should be immune from litigation.
2) Alternative forms of non-fault compensation to possibly apply.
3) Medical practitioners should generally be immune from discipline subject to certain basic exceptions on condition that they provide full and frank disclosure of their mistakes which would not be able to be used in litigation.
4) Suggestions for spending on legal costs to be reduced.

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Chapter 28 - The Future of the NHS

This is a summary of chapter 28 - Medical Negligence Claims. It was written by Dr Gerard Panting, Director of Policy, Medical Protection Society.

In this chapter he provides a guide to the NHS Redress Bill which is aimed at improving procedures for dealing with clinical negligence claims, both in terms of helping victims and in reducing costs. Ultimately, he believes the success of the Redress Scheme will depend on how individual trusts manage the process at local level, and whether there is counter shift away from attributing blame, towards preventing harm reducing risks and learning from mistakes.

The scheme is to be overseen by the National Health Service Litigation Authority (NHSLA) and he raises questions as to its impartiality, and also whether it will have the resources properly to investigate what the acceptable range of practice was and whether the work came within it.

Ultimately his belief is that the scheme is likely to result in more patients with low value claims coming forward to use the scheme.

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Chapter 27 - The Future of the NHS

This is a summary of chapter 27 - From self-regulation to professionally-led Regulation in Partnership with the Public.

It was written by Dr Joan Trowell a University Lecturer in Medicine and a Consultant Physician at the Oxford Radcliffe Trust. She is a member of the General Medical Council and until recently she was chairman of the GMC’s Fitness to Practise Committee. It was also written by Mr Paul Buckley, the Director of Strategy and Planning at the General Medical Council (GMC).

This chapter examines the changing face of professional regulation. While the focus is largely on the GMC, the trends identify conclusions, intended to apply to the regulation of healthcare professionals more broadly. Many changes have already occurred, but some would advocate yet further change. Given the clear willingness of regulatory bodies to reform radically, further imposed structural change for its own sake, or for the sake of continuing the momentum of change, cannot be the answer. The effect of the recent reforms requires adequate evaluation.
They suggest that the new model of regulation, which is emerging, retains the strengths of professional ownership, but balanced by full public involvement. This is the true meaning of professionally led regulation in partnership with the public.

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Chapter 26 - The Future of the NHS

This is a chapter summary of chapter 26 - The Future for Health Care Management: an Analysis and Some Proposals. It was written by Professor Ewan Ferlie, Director of the Centre for Public Services Organisations and Head of the School of Management, Royal Holloway University of London

In this chapter he argues that 'better management can lead to better health services', via the slogan ‘better management; better health’. He sees a core management task involving active leadership from both general managers alongside clinicians, to inspire and sustain collective service improvement activity rather than ‘form filling’ management, for proliferating audit systems. He suggests the need for more local and long term strategies and fewer top down quick fixes. He believes health care management should be based on a secure evidence base as well as clinical practice. He offers analysis and a 4 point agenda for management in the medium to long term.

1) Stabilising The System: Less haste; More speed.
2) Getting Doctors into Management and Developing Medical Leadership
3) Strategies with Private Sector Providers
4) Developing an evidence based method for NHS management.

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Chapter 25 - The Future of the NHS

This is a summary of chapter 25 - NHS staff. It was written by Dr Chess Denman a Consultant Psychiatrist in psychotherapy at Addenbrookes hospital where she runs the Complex Cases service which specialises in the treatment of personality disordered patients. Dr Denman is the secretary of the Royal College Faculty of Psychotherapy, a member of the Society of Analytical Psychology and a founder member of the Association of Cognitive Analytic Therapists.
Mr Daniel Barnett a leading Barrister in employment law and author of three employment law textbooks, including co-author of the Law Society Handbook on Employment Law. He has advised and defended a number of NHS trusts in unfair dismissal and discrimination claims. He frequently comments in national and specialist press on employment law matters. Also Dr Colin Payton a Consultant Occupational Physician and Clinical Director of Occupational Health and Safety at the Royal United Hospital, Bath.


This chapter describes how the NHS (the fifth largest employer in the world) has reported 36% of their staff have suffered work-related stress. Psychological ill health remains potentially the most serious problem for the health and well-being of NHS staff. What does not emerge from the statistical and survey data are the human stories which surround psychological ill health in hospital staff, many of whom are there caring for others. Doctors take the fewest days off sick but have high rates of suicide. It also seems unfortunate that there are increasing numbers of health care workers with alcohol misuse problems and more recently with other substance misuse problems.

With this in mind this chapter provides some positive suggestions for change in relation to improving the care of the nation’s carers. They fall into two categories. First, improved access to psychological care and second, more employee focused employment procedures.

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Chapter 24 - The Future of the NHS

This is a summary of chapter 24 - proposals to improve clinical academic training. It was written by Professor David E Neal and Professor Mark Walport. Professor David E Neal is Professor of Surgical Oncology at the University of Cambridge & Member of PMETB. He is an elected member of the Council of the Royal College of Surgeons of England and a past Chairman of the SAC in Urology. Professor Mark Walport FMedSci, FRCP He is the Director of the Wellcome Trust and Chair of UKCRC & MMC Academic Careers Sub-committee.

In this chapter they address the importance of an academic career including researchers and educators by considering the following issues:
1) Academic medicine as a career had been under threat with warning bells ringing for some time over the perilous state. Several reports highlighted difficulties facing clinical academics, as they attempted to negotiate the hurdles of dual training in clinical and academic skills. Fortunately, an increase to NHS Research and Development funding and the promotion of a partnership approach to strengthen clinical research.
2) The increasing the strength of academic medicine to improve expertise in clinical research and education is of great benefit to the NHS and the wider academic and business community in the UK.
3) Overall, the prospects for academic medicine are improving, and depend upon working with the Colleges, Faculties and Specialties to ensure that new academic programmes are coherent with changes in training. If there continues to be real commitment to improve careers in Clinical Academic Medicine, then they expect prospects to be good and the declining number of academics to be reversed.

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Chapter 23 - The Future of the NHS

This is a summary of chapter 23 - training for a new NHS. It was written by Professor Shelley Heard and Professor Elisabeth Paice. Professor Shelley Heard trained as a medical microbiologist. She has been a chief executive of an acute trust and for the last 10 years has been a postgraduate dean for medicine in London. She is also currently the National Clinical Advisor for the Modernising Medical Careers (MMC) programme. Professor Elisabeth Paice MA FRCP She is Director of Postgraduate Medical and Dental Education for London. She developed the Hospital at Night concept and has published on stress in doctors; doctors in difficulty; workplace bullying; flexible training; and other aspects of medical careers.

They describe how medical education in the UK has an international reputation for excellence, and our own graduates are eagerly sought after by other countries. Nonetheless, there is plenty to improve about the way we train doctors, and there are powerful drivers to do things differently. Whatever else is needed to support the vision of a future better NHS, education must be right up there. It explains the recent changes in medical school training, and the new terminology, such as Modernising Medical Careers (MMC), and the new standards set by the Postgraduate Medical Education and Training Board (PMETB).

They discuss the issue of healthcare being a twenty-four hour business, but that the move to a twenty-four hour society has not produced twenty-four hour people. Night working is intrinsically stressful, error-prone and socially undesirable, and no vision of the future NHS can ignore the damaging effects of night work on its staff. The European Working Time Directive has proved a powerful driver for change to long hours, but in some cases, shortening the hours has simply resulted in excessive work intensity.

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