Last reviewed 22 October 2013

Monitor has published a report to encourage a debate about how the NHS can address a forecast funding gap.

Closing the NHS Funding Gap: How to Get Better Value Health Care for Patients says the NHS will need to change radically if it is to close a funding gap while providing good-quality services to patients that are free at the point of use and fit for the needs of patients in the 21st century.

Projections from the Nuffield Trust and NHS England suggest the NHS funding gap could grow to £30 billion a year by 2021, although this figure could be smaller if the economy as a whole expands faster than expected.

NHS England has called for an “honest and realistic debate” about the challenge and is supporting Monitor, as the sector regulator, to start off with this report, which outlines the opportunities available to deliver better care and reduce the financial shortfall. The report puts forward ideas including:

  • improving productivity within existing services

  • delivering the right care in the right settings, including increasing care in the community

  • developing new, innovative ways of delivering care

  • making “one-off” reductions in capital expenditure and staffing costs

  • changing the way health spending is allocated, which is currently based on historic demand.

Monitor chief executive and chair David Bennett said that achieving this will not be easy: “While there are individual things the sector can do — like be more efficient in its procurement or introducing new ways of working in hospitals — what is required is a step-change. In short, the NHS must undergo radical change if it is to survive.

“Monitor, as the health sector regulator, will not only be supporting, but actively enabling changes that deliver better services for patients and reduce costs.”

The NHS Confederation recently announced: “If we do not achieve a post-election drive for change, it is very possible that the current basis of the NHS, free for all at the point of need, will become unsustainable in the future.” It has just unveiled its “2015 Challenge” to politicians to create the space for change essential for the NHS’s future. In return, it says, the NHS should be ready to make the change “and do it well”.

It said that at the next general election the main political parties must share an analysis of the challenges facing health and social care, which should ring true with those in the health service, and must not be overly prescriptive in their manifestos, and that the “deal” between the NHS and politicians over conditions for political consent to change is “clearer and can be articulated in a way that the NHS locally can ask candidates to sign up to the principles”.