Lord Darzi’s 2018 report, Better Health and Care for All, published by the Institute for Public Policy Research, provided evidence that the NHS needs to move on From a regime of performance management focused on driving activity, to a more holistic view of patient care focused on delivering higher quality services. CF was the analytics partner and lead author and Ruth Carnall, chair of CF was a member of the advisory panel.
- The report determined that quality in the past decade had been maintained or improved but access and finance had deteriorated
- Provided the first new numbers for funding required for health and care through to 2030
- Offered a 10-point plan for health and care reform with bold measures such as a ‘tilt towards tech’
- Proposed 3.5% annual increases in NHS funding between now and 2030 and a way to pay through increased national insurance contributions
A need to know where next
The NHS was approaching its 70th birthday, had reached the fifth year of its long-term planning approach (Five Year Forward View), and was dealing with significant strain created by austerity measures.
The Institute for Public Policy Research (IPPR) realised the need for new analysis and thinking on the NHS which would set its future direction. They engaged Lord Darzi to provide oversight and leadership on a new report and commissioned CF to lead on analytics and authoring.
As well as focusing on funding requirements for the NHS and concrete policy forms, the report addressed the relationship with social care to determine the benefits of a more holistic and integrated approach to health and care. Before looking to the future, the report took a holistic look back at the past decade.
A detailed collaborative process
We co-designed the overall approach to the report in partnership with IPPR, confirming aims, methods and timings of our work. A key component of the approach was establishing Lord Darzi’s advisory board of national thought leaders. Ruth Carnell, chair of CF was appointed to the panel.
To efficiently analyse several hundred measures of quality and access at pace, we adopted a hypothesis-driven, problem-solving approach. This involved utilising healthcare analytics, across decades of data for hundreds of metrics, to produce robust analysis.
We also leveraged our ‘whole healthcare’ economy modelling approach that has been tested and validated by Paul Baumann, the chief financial officer of NHS England for 11 years. We tested and iterated analysis every week internally with CF partners and externally with IPPR.
Findings were distilled into powerful charts and critical messages and tested monthly with Lord Darzi and the Advisory Board. We worked with IPPR to determine optimum points for publication to maximise impact with the media and on political timelines.
While population health had generally improved since 2008, obesity had worsened, especially in children, and the inequality of outcomes had increased.
Quality of primary care and social care had improved since 2008. Within the acute area, cardiology, stroke and cancer care has especially improved.
Access to publicly funded care had dropped, notably same-day GP appointments. Urgent and emergency care had hit crisis levels.
Current levels of funding were determined to be unsustainable in the face of ageing demographics and productivity was at unsustainable levels.
The significant policy implications were the need for integrated health and social care, simplified NHS governance structures, and encouragement and facilitation of technological and digital adoption.
The interim report was published in April 2018 and the full report in June 2018. Both received extensive press coverage. The report was discussed with the prime minister and received praise in parliament from the health secretary, Jeremy Hunt, who announced 3.4% annual increases in NHS funding between now and 2030 – just 0.1% away from the report’s recommendation.