The move from STPs towards ICSs represents an exciting opportunity to change the way the NHS thinks about its role as a local economic player, writes David Maguire
Just over 1 in every 50 people in England work in the NHS. There are only seven other employers in the world that employ more people and most of those are Chinese state companies. But is the NHS making the most of the economic power this gives it to improve the health of the people it serves?
It’s well-established now that the main determinants of our health are not the quality of services we are provided with, but socio-economic factors that are beyond the control of clinicians. But when you’re responsible for nearly 7 per cent of local jobs, (as the provider sector is in Birmingham and Solihull), there are opportunities to influence these wider determinants of people’s health.
The King’s Fund has just published a new analysis of the NHS provider sector’s economic influence at a local level, looking at how many jobs it provides and how they pay. Particularly in poorer areas, we find that the NHS is providing high quality, financially-rewarding jobs and is often the largest employer in these areas and a lucrative source of contracts to local suppliers.
We know that the NHS is moving towards a population health model of care in the coming years, and the move from sustainability and transformation partnerships towards integrated care systems represents an exciting opportunity to change the way the NHS thinks about its role as a local economic player.
Traditionally, the impact and performance of the NHS has been measured by inputs and outputs – access targets and levels of activity. While access standards are an important measure of how the NHS performs, they fail to tell us the full story of how the NHS improves people’s health.
What is the objective of NHS spend? Efficiency of spending or maximising health gain? Surely if it’s the latter, then the NHS should be looking at the social value of its work as a key outcome in order to affect the wider determinants of health?
And if leaked changes to the Treasury’s return on investment calculations go ahead, the local impact of public spending is set to become more important than ever.
Why should healthcare spending be treated differently to other areas of public finance? No other public service holds the same level of direct economic influence as the NHS, whether you look at the number of people employed or the amount of money spent.
The NHS long-term plan makes a passing reference to how the health service can do more for local communities, but this could be a unique opportunity for the whole NHS to look at itself in a whole new way.
These are not new concepts or untested ideas. Many areas across the NHS are already beginning to think like this. Places like Leeds, Birmingham and East London are trying to address both their workforce supply and population health needs by offering employment, apprenticeships and support to people in their local community. Provider organisations are also looking at how they procure and pay suppliers, so that more money spent by trusts stays in the local economy.
At the moment, these ideas are being taken up by innovative local areas that find the time and space to experiment with the unusual, but largely unnoticed or dismissed by the rest of the system.
This risks missing an opportunity to shift the focus from service delivery to improving the health of the nation.