£30 billion!

That's some sum!  And it was that sum of money we were discussing at the DH on Wednesday at the Provider Forum. It’s the funding gap the NHS faces by 2020 if the service continues in its current form against cost trends.

Sir David Nicholson has been up front this week in demanding that we start thinking about the changes needed in the health service if we are to overcome this funding gap. He was great on the Today programme when he explained how we need to reconfigure the service. Moving resources from hospitals into prevention and community support.

He said,

 "It's a really stark choice for us, do we go for service change, changes in the way we deliver services to patients or do we sleepwalk into a position where we reduce the quality for patients."

He warned that: "If we don't tackle these issues now and over the next couple of years - the future for many of our organisations is facing those very dangers that Mid Staffordshire faced during the years it was involved in this terrible tragedy."

He’s right. As I said at the Provider Forum, recalling what one of my members told me; funding cuts are not necessarily a disaster but cutting and expecting to deliver the same service in exactly the same way is.

The fact is the NHS does not need more money to meet the £30b gap, even if that were available. It needs to reconfigure the service, close hospitals and move money into prevention and community support that keeps people out of hospital and, longer term, cuts costs.

Politicians need to show leadership in making this case and not just David Nicholson. One lives in hope.

Amusingly as I was blogging I had a phone call from the British Heart Foundation (I support them) asking me to increase my donation to aid their research programme. I was delighted to do so, (please note Institute of Fundraising; CEOs do take an interest in fundraising!). This was   partly because good friend and acevo Member Simon Gillespie runs it! But the charming fundraiser who spoke to me reminded me that coronary heart disease remains our biggest single killer, yet increasingly we can help people survive attacks by supporting their recovery through diet, exercise and community support and advice. When the NHS model was set up in 1948 heart attacks killed almost everyone. Not now. The same is true of cancers. That stunning and superb success has consequences for resource allocation.

 There is some extraordinary medical research discovering new cures and treatments. Some of the world's greatest professionals and doctors working in Institutes and research centres (often funded by charities). An example of this was announced this week trials of a new drug that prolongs life for those with advanced prostate cancer have been highly successful and can prolong life expectancy significantly. Indeed there are 402 drugs to treat prostate cancer currently in development. This is a disease that currently kills 11,000 men a year, with 41,000 new diagnoses each year. And growing.  All power to the arm of these researchers. But it means more specialist care and centres of excellence, (not the district general hospital approach), combined with community care and prevention.

 But we also need to accept that choice and competition will play a part too. Delivering more choice for citizens in the service they own is essential and for that we need more diversity of delivery bodies. Time for someone to champion this cause inside the NHS instead of treating it like its a disease.

There is a lesson here for the Tories. They have gone very quiet on choice and competition and have been less clear on hospital closures. Yet I would worry that many in their Party would argue that the funding gap be met by charging people to visit their GP or other charges on services, or by incentives to opt out of the NHS into private health care. That is the real policy challenge we may face over the next 5 years.  

 There is a lesson here also for Labour in that what matters is that the NHS continues as a free and universal service. That is not the same as arguing that service must be provided by employees of the State. If we are to move resources into prevention and community we need a massive flowering of our charity and social enterprise sector. We need to commission and contract them. We need incentives to get them into bigger scale delivery and encouragement to consortia and partnerships and more opt outs. We need barriers to delivery smashed (and the NHS culture is one of the biggest problems).

 At the moment some CCGs see this need to radically change commissioning patterns. But many do not. Andy Burnham has been right to push the case for social care and health integration. But inevitably that also points to greater choice and hospital reconfiguration and closures. 

We have yet to see any of the political parties biting that bullet. So Nicholson and increasingly others in the management of the NHS are right to push the cause. We need to build this case. Perhaps the public are getting more savvy about this in the wake of scandals like Morecombe Bay and Mid Staffs- increasingly we understand that care is patchy.  Some hospitals ought to be closed on safety grounds. And travelling a bit further to get better treatment is not a bad thing. If you can stabilise soldiers who have had horrific injuries in Afghanistan and fly them back to Birmingham for successful treatment then an extra 20 miles to a good A+E isn't going to be life or death. After all, in London, if you have a stroke you will be whisked off- not to your nearest A+E- but to a hospital that specialises in stroke. And death rates have plummeted.

With long term conditions continuing to grow. With demographic change. With medical advances moving the goal posts, we have to change the 1948 model of hospital dominance to community and prevention. And we need an NHS that actually does put citizens first.