Workplace health: Key to NHS reforms

The Conservative Party has pledged to defend the NHS over the next parliament. But it will need the support of employers’ workplace health strategies to succeed, says Sam Barrett

Having secured a majority government, the Conservative Party is set to spend the next five years delivering its manifesto promises on healthcare. And, with healthy employees critical to business success, the way in which the future of the NHS is tackled will shape the healthcare benefits market.

Funding challenge

The key challenge will be addressing the future funding of the NHS. The
success of this will have ramifications for employers because any change to NHS waiting times can have implications for the amount of absence across a workforce. For this, the Government is sticking with the NHS’s own action plan, the Five Year Forward View, and committing a further £8bn a year above inflation by 2020. This level of funding, alongside efficiency savings and transformational changes, should hopefully be enough to plug the £30bn funding gap that the NHS report predicts will emerge by 2020 if no action is taken.

However, while it represents a significant investment, there are already concerns that this figure simply will not be large enough.

For Civitas healthcare researcher Edmund Stubbs, the pressure on delivering efficiency savings could prove too high. “The £8bn-a-year pledge is extremely welcome. However, for this to keep the NHS even economically viable, we would still have to make £22bn of efficiency savings over the coming parliament,” he says.

“This would mean almost tripling current efficiency efforts, which is an extremely optimistic scenario considering the hardship arising from current efficiency drives throughout the NHS.”

Others, including NHS England chief executive Simon Stevens, who is author of the action plan, are more confident that the necessary level of savings will be achieved.

Speaking a week after the general election, Stevens said he was optimistic – given the support the NHS was receiving – but acknowledged that future funding streams were dependent on how radical and successful the NHS was on prevention, care redesign and its broader efficiency programme.

For Deloitte UK Centre for Health Solutions director Karen Taylor, returning the Conservatives to power, albeit without the need for a coalition partner, will mean little change in the direction of travel.

“The health policy of the coalition government was largely dictated by the Conservatives so I don’t expect to see a significant change in direction,” she says.

“However, the Government will need to be more radical over the next five years to drive the transformation that is required within the NHS.”

Transforming health

Although these projects are still in their formative stages, there are already indications that the NHS will take a more radical approach to reform than it has in the past.

Part of this involves the establishment of a series of vanguard sites throughout the country to develop new models that will transform the way care is delivered locally. 

So far, 29 vanguard sites have been selected from more than 260 organisations and partnerships that expressed an interest, and further waves are planned for later in the year. Taylor says the ones selected have made inroads into transforming the care model.

“Many of them are using technology to deliver their services and I believe this will be a key lever in the delivery of improvements,” she says, pointing to one of the vanguard sites, Airedale NHS Foundation, as an example.

“They’re looking at how to deliver more joined-up care to older people and have been using tele-health technologies to enable this. It will be good to highlight these different ways of working.”

The other key element of the Government’s strategy for NHS transformation is prevention, with a campaign proposed to tackle the UK’s obesity crisis. This would include public awareness campaigns but also dialogue with food manufacturers to encourage a reduction in the amount of sugar in processed foods.

Indicative of the radical stance that could be taken, there have also been hints of a sugar tax from the NHS’s Stevens, although this is not strictly in line with the Government’s position.

Meeting consumer demand

Another key manifesto promise that could affect employers is the introduction of seven-day-a-week GP services. Being able to see a GP quickly and at a convenient time can have a major impact on employee absence, with weekend appointments and the use of more technology removing the need to take time off to see a doctor.

Unfortunately, the shortcomings of the GP services currently in place can be seen in figures from the Royal College of General Practitioners (RCGP). It estimates that patients will wait a week or more to see a GP on 67 million occasions in 2015.

Addressing this by moving to a seven-day-a-week service will cost the NHS £400m over the next five years but, according to the findings of pilots run in 2014/15, this could be recouped in other areas. In particular, the pilots noted a reduction in A&E attendance of between 10 and 15 per cent, rising to 25 per cent in some areas. Extrapolating these findings across England, this represents 2.2 million fewer A&E visits a year.

While these benefits are compelling, there are question marks over the Government’s ability to implement a seven-day GP service. Although it
has said it will train 5,000 more GPs by 2020 to help deliver the service, the RCGP says the UK needs double this number of additional GPs to deliver a truly responsive service.

In addition, where technology is used to facilitate seven-day access, the Government may need to be careful about how it is implemented.

Research by the University of Exeter Medical School found that, rather than reducing a GP practice’s workload, patients who received a telephone call from a GP were more likely to require further support or advice than those who had a face-to-face appointment.

While this may be addressed through the work being carried out in the vanguard sites, moving to seven-day GP access is clearly not without its challenges.

Employer role

While the plans are ambitious, they create opportunities for employers to play a larger role in supporting employee health. If the extra funding and other reforms prove insufficient, waiting lists will increase, making medical insurance and cash plans more attractive employee benefits.

But, even if the plans are successful, employers could still find themselves filling some gaps. For example, Taylor believes there will be a need for some rationing within the NHS.

“This already happens to some extent,” she says. “For instance, the morbidly obese are turned down for some types of surgery and I can only see this happening more and more.”

The awareness campaign planned by the Government sits neatly alongside employer health and wellbeing campaigns. While employers may choose to complement the Government’s campaign, it is also likely that the workplace will be a key distribution channel for some of the messaging.

And, although politicians have been reluctant to incentivise employers to provide healthcare benefits, many believe this may change.

Stubbs says: “It makes economic sense for the Government to work with employers to prevent their employees becoming ill in the first place. This will keep their productivity at a maximum and help to reduce their utilisation of NHS services if they become ill.” 

There is also a precedent set in the £500 employee tax break, which was introduced this year for return-to-work health interventions. Although only a small amount, this, coupled with the Fit for Work service, encourages employers to invest in appropriate treatments for employees who are unable to work due to illness or injury.

However, Canada Life Group Insurance marketing director Paul Avis says the jury is still out as to how successful this first piece of collaboration on employee health will be.

“I fear that, without any obligation on the employer to accept the recommendations of the Fit for Work service, it won’t lead to a significant improvement in long-term absence,” he says. “It’s still early days but it may be no better than a blow on a bruise.” 

But with the Government setting ambitious targets for the NHS, the need to find new and more radical ways to improve public health and control the cost of healthcare is likely to encourage more dialogue with employers, with further incentives no longer unthinkable.

Conservative manifesto commitments

The Tories made some key promises relating to the NHS in their election manifesto. These included:
– Spend at least an additional £8bn a year above inflation by 2020 to fund and support the NHS’s own action plan for the next five years
– Ensure everyone can see a GP and receive hospital care seven days a week by 2020, with anyone over 75 able to get a same-day appointment if required
– Integrate health and social care through the Better Care Fund

To help achieve these promises, the Tories committed to a further range of measures in the run-up to the election. These included training 5,000 more GPs by 2020, ensuring psychological therapists are available throughout the UK and providing access to mental health support for women during and after pregnancy. They also vowed to cap public sector redundancy pay-offs at £95,000 for staff earning more than £27,000 a year.