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A well known example of this tension in action is the uptake of innovation in the NHS. This was also picked up in Lord Darzi’s review, where he states that "a change in culture" is required, and that this should be achieved by demonstrating the benefits of innovation in terms of improved safety, effectiveness, personalisation, fairness and value. His solution is to create a Health Innovation Council (HIC), "to act as the overarching guardian for innovation from discovery to adoption". More specifically, it will advise ministers on issues relating to improving patient access to "cost effective new medicines, medical technologies, procedures and processes", and encourage "greater adoption of models of care where there is good evidence of improved outcomes." The membership is drawn from the DH, the healthcare industry and the research community, and will be supported by a £100 million fund provided jointly by the DH and Wellcome Trust.
HIC is chaired by Lord Darzi, who is also responsible for delivering a wider innovation agenda across the DH. He is being assisted by Mark Britnell, Director General of Commissioning and System Management and a former chief executive of University Hospital Birmingham NHS Foundation Trust. It is, however, important to note that HIC defines innovation as including clinical practice and service delivery as well as medical technology. It is also interesting to see that the DH sees more efficient and effective procurement as being a "a facilitator of innovation" - the key issue is how to ensure this happens in practice and a number of initiatives are now including pharmaceuticals and medical technology.
What do these debates mean for patients and the wider public? The reform programme has certainly delivered improvements, particularly in terms of access to emergency care and secondary services. However, there is still widespread concern about growing health inequalities, unequal access to treatments and variations in the quality of chronic disease management. The Government has identified all these issues as priorities for the next three years and included them in the Public Service Agreement (PSA) targets announced in October. These were published with the results of the Comprehensive Spending Review (CSR), which sets out public spending for the next three years.
The Government has also confirmed it will be holding a consultation this year on the reform of the adult care and support system “in order to ensure an affordable system in is in place for the 21st century.” The health and social care systems are increasingly struggling to manage the growing number of elderly people living with long term conditions or in need of more general practical support. Lord Darzi will also publish his final conclusions in June in time to celebrate the 60th anniversary. The NHS looks set for another exciting – and highly political – year of debate.