The past year has been one of continued and unrelenting challenges for the NHS with healthcare dominating the news and public policy agenda throughout 2014.

In the face of year-on-year increases in demand, the NHS has continued to provide care for increasing numbers of patients. However, as a result of funding and capacity constraints many NHS organisations are now reporting financial deficits, staff shortages and a deterioration in performance against NHS targets. Other challenges, including escalating crises in primary and social care, have become more prominent. As we enter the 2015 election year the NHS faces a mounting array of financial, workforce, performance and quality challenges compounded by increasing patient expectations and regulatory scrutiny and the certainty that it will be one of the key, if not the key, election issue.

In 2014, the NHS continued to enjoy high levels of public satisfaction with many examples of heroic actions and important breakthroughs in the care provided, but it also attracted more than its fair share of criticism, mostly around quality, equity and access to services. Given the almost universal acknowledgement of the need to provide healthcare free at the point of need, there is political acceptance that more funding will be needed, albeit differences of opinion as to how much and where the funding will come from. However, many of the solutions to the perceived NHS crisis appear to focus more on the supply side (changing organisational structures and increasing the numbers and pay of NHS staff), rather than on moving the management of demand upstream and working differently. In considering how things might be done differently in 2015, notwithstanding the hiatus that the election is likely to create, I thought it might be interesting to reflect back on the key events of 2014, these include:

  • January - the ongoing debate about, which started in January 2014 has continued throughout the year but with limited evidence, as yet, of a workable solution.
  • February - the first anniversary of the report on the Francis Inquiry continues to reverberate across the NHS including being the main driver behind the increasing numbers of nurses employed by NHS hospitals during 2014.
  • March - the Chancellor’s Budget, confirmed protection of the NHS budget but introduced further spending cuts to most non-protected departments, including local government, leading to tighter eligibility criteria for adult social care. At the same time a pay dispute erupted when the NHS Pay Review Body’s recommendation of a one per cent increase was rejected. Instead, a two-year deal was put forward offering a one per cent increase to those staff who were not entitled to incremental rises.
  • April - Simon Stevens took over the reins at NHS England. The Prime Minister committed to training 10,000 more community nurses over the next six years, as part of plans to shake up general practice.
  • May- the Care Bill received Royal Assent. Health Education England and the Nursing and Midwifery Council launched a major review of pre- and post- registration education and training the Shape of Caring review (findings due in early 2015).
  • June/July - as the NHS moved into the summer months, the anticipated slowdown in demand failed to materialise and the NHS continued to face growing demand for services, leading to increasing concerns over the solvency of some NHS provider organisations. Meanwhile the National Institute for Health and Care Excellence published guidelines on safe staffing levels in adult in-patient wards suggesting that there should be no more than eight patients per registered nurse during the daytime or fewer than two nurses present during any shift.
  • August - analysis by a number of academic and research institutions added to the growing body of evidence of the need for further funding for the NHS which in turn led to an announcement in the Autumn Statement of additional NHS funding of £2 billion in 2015/16.
  • September - the annual party conference season saw all political parties holding high profile debates on the problems and potential solutions for the NHS. At the same time concerns over the growing Ebola outbreak in West Africa escalated and Public Health England announced a national response.
  • October -the publication of Simon Steven’s Five Year Forward View, welcomed by many commentators as a much needed strategy document to frame the future direction of health policy. While there is a general consensus of support for the proposals, the political parties have conflicting views on how to bridge the funding gap. October was also the month when thousands of nurses and midwives took part in strike action -the first time in the Royal College of Midwives’ 133 year history that its members took strike action.
  • November - six months before the general election, coincided with increasing evidence of a growing crisis in general practice. A legal duty of candour came into force in England, requiring NHS organisations to admit when patient safety errors have occurred.
  • December - the NHS was firmly ensconced on the front page of most newspapers with stories of “no room at the inn”, excessive breeches in waiting time, financial bail outs, cancelled operations and long waits to see a GP and NHS dentist.

The above represents only a small selection of the numerous defining moments of 2014 but, as we head into the General Election in 2015, there is an increasing feeling of Deja-vu. In 1997, the Labour government was elected on a platform of ‘24 hours to save the NHS’ and what followed was six per cent year-on-year increases in NHS funding, between 2002 and 2008, with the recruitment of many more staff, paid more, but with little success in getting them to work differently. As we enter 2015, any funding increases will be limited, so it will be important to identify and understand how to change ways of working and improve the economy, efficiency and effectiveness with which NHS resources are used.

We also need to find a way of balancing the media coverage, by recognising the vast improvements that have been seen over the past 15 years. For me, these include: large scale investment in the NHS infrastructure; tremendous advances in medical imaging, new life extending treatments for many diseases; improved awareness of and approaches to health and safety risks; and better patient engagement and involvement. Overall, there is a need for more recognition to be given to all the many positive things that happen every day across the NHS and the sheer resilience, commitment and dedication shown by its staff in the face of unrelenting demand.

Indeed in every issue I’ve researched over the past 15 years there is evidence of innovative ideas being tested and new models of care adopted, but what has continued to undermine progress is the wider scale adoption of this good practice. With advances in data analytics and technological innovation, access to this evidence base has never been easier at the same time the transparency agenda means failing to adopt and comply with good practice will be ever more evident. So let’s hope this time, whatever the political landscape, the NHS will truly start to work differently and preserve its place in the nation’s hearts.


Karen TaylorKaren Taylor
Research Director, Deloitte UK Centre for Health Solutions




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