1. Robert Hill Consulting What does the future hold? And how can nurse leaders influence it?

2. Robert Hill Consulting The big picture on spending Government plans to halve the deficit over 4 years by 2013/14 Action to do this covers three areas: –Growing the economy to increase tax revenues –Raising taxes - £19 billion –Cutting spending - £38 billion (around £20 billion of this sum has been identified and the rest hasn’t as yet)

3. Robert Hill Consulting Public spending 2011/12 – 2014/15 Source: IFS

4. Robert Hill Consulting Some DELs to be protected… Overseas Aid –Meet 2013 target of spending 0.7% of Gross National Income Health –Real freeze in ‘front-line’ spending Education –0.7% real increase in ‘front-line’ schools spending –0.9% real increase in ‘front-line’ spending on 16-19 participation –Real freeze in ‘front-line’ spending on Sure Start

5. Robert Hill Consulting …which means less for other departments Source: IFS

6. Robert Hill Consulting Cuts announced to date 1% cap on public-sector pay to reduce spending by £3.4bn Cuts to lower value spending programmes worth £5bn Cap on employer-pension contributions saves £1bn Efficiency savings of £11bn –Some of which have been achieved but some not –Ambitious future targets

7. Robert Hill Consulting Health has to generate the highest efficiency savings in cash terms… £ billion Source: IFS

8. Robert Hill Consulting There is more to come Another of £18 or so billion of cuts to be specified Conservatives would start sooner (this financial year) and cut deeper –But give the NHS real term savings –But cut NHS administration by a third –And stop the forced closure of A&E and maternity units Scotland, Wales and Northern Ireland will proportionately be affected in the same way – They will have discretion as to apportion the cuts

9. Robert Hill Consulting …but not in percentage terms Percentage of DEL Source: IFS

10. Robert Hill Consulting Funding is not the only challenge facing the NHS… More choice and power for patients –Guarantees and choice of provider –Personal health budgets (integrated with social care) Diversity of provider organisations and greater competition between them Commissioning based on pathways of care –More care closer to home –Polysystems Increased co-payment –Reform of social care Continuing workforce reform

11. Robert Hill Consulting …there are other challenges as well Rising and ageing population –Increasing life expectancy Growing diversity New drugs and treatments Digital revolution Public health –Rising obesity –Great emphasis on prevention –Continuing inequalities on society

12. Robert Hill Consulting The response locally… Have a medium term plan –Be strategic don’t go for incremental cuts year by year –Use process re-engineering to look at things from first principles Be clear about priorities Act with partners – Total Place Use opportunity provided by creation of arms length provider units for community services –Social enterprises Communicate with staff continually and engage them in change

13. Robert Hill Consulting …and nationally Freedom of information evidence Parliamentary questions and debates Select Committee reports Media reports and campaigns Petitions, letters and surveys Legal challenges Visits Well-evidenced reports Organisational muscle

14. Robert Hill Consulting Board level discussions and plans Responses to public consultations Freedom of information requests Demonstrations of replicable innovative practice Policy studies backed by action research Conduct surveys and publish results Getting alongside key opinion formers –Talk to SHA, Visits, Chatham House rules events Using MP visits and discussions RCN position and discussion papers Key levers that nurse leaders can use