A 21st century NHS: procuring to meet the aims of a National ‘for Health’ Service

Procuring to meet the aims of a National ‘for Health’ Service could extend and futureproof Bevan’s vision of free healthcare for all, says AECOM

Few institutions engender as much deep-seated affection, emotion and passion as the NHS and the founding principle of quality healthcare being available to all is as relevant today as it was 67 years ago.
Measured on global metrics, coverage and healthcare and lifestyle outcomes, the UK’s NHS is undoubtedly a global success. Yet it is at a critical crossroads due to economic factors dictating affordability and availability, as well as an ageing – not to mention increasingly obese – population, with ever more complex healthcare needs. 
With a growing disconnect between the expectations of patients and politicians and what NHS staff are able to deliver with the resources available to them, a shift towards a more innovative National ‘For Health’ Service is becoming necessary. 
From new cycle-ways to health improvement campaigns for better diets, as well as measures to more appropriately align social care budgets with the needs of the ageing population, the focus is increasingly on prevention of illness. Successful examples of this reprioritisation of healthcare budgets include parts of London, Northern Ireland and Manchester – appropriate for the city that is itself a major catalyst for the Northern Powerhouse.
It is a moot point whether this shift needs to be accompanied by further organisational change, something many in the service continue to struggle with. 
The role of capital expenditure – although dwarfed by operational spend  – is key to overcoming the challenges that lie ahead. It comes down to getting more out of the NHS’s capital assets. Moves stimulated by the Cabinet Office and others away from retaining the past holding of capital assets in favour of focusing on singular estates to encourage more effective use of capital will enable healthcare to be better targeted at the citizens. 
This will require boldness of vision from politicians, civil servants and healthcare leaders. All too often the vociferous voting public sees hospitals as synonymous with healthcare delivery, stoking political and emotional debate about saving buildings. But how many of the UK’s hospitals – in terms of location, building design and facilities – are equipped to meet the evolving needs of the population? 
The focus needs to be on healthcare delivery, not the buildings that house the healthcare. There is too much attachment to hospital buildings and insufficient credence given to how different and updated configurations of services could improve healthcare outcomes, even if that means selling the local hospital to finance new, improved services including new facilities in better locations. 
There are numerous examples in the NHS of where technological innovation is helping achieve more targeted use of assets. Procuring to meet the aims of a National ‘for Health’ Service rather than procurement at a tactical, individual health estate level could extend and futureproof Bevan’s vision of free healthcare for all.


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