The NHS in England is facing an unprecedented financial challenge with efficiency savings of £20 billion required before 2015. Many international health systems have experienced similar challenges in recent years and this project seeks to learn valuable lessons from the tough decisions they were forced to make.

The scale of the financial challenge facing the NHS will require more than simply improving the efficiency with which existing services are delivered. The way health care is delivered will require significant service redesign, such as shifting large enough volumes of care into the community to allow hospital beds to be closed.

The need to make significant savings and to withdraw investment from existing services is a situation that other countries have faced, in some cases in response to previous economic crises. We are examining the experiences of a number of other countries to try and understand the cost-shifting measures and budget reduction strategies they implemented, and the impact of those reductions on health care over time.

Many international health systems have faced the kind of efficiency challenge now facing the NHS – this project aims to learn from their experiences

One of the countries we are investigating is Canada, which went through a recession in the early 1990s. The Canadian health system was forced to undergo major reductions in spending which led to a number of changes to patient services.

We hosted a masterclass in London in May 2011 with senior officials and managers from Canada who were involved in decision making at the time. The aim was to offer a real-life perspective on how decommissioning and hospital closure decisions were made and justified, reactions from doctors’ associations managed, and how the Canadian health service was managed during the period of subsequent economic recovery.  Video interviews with keynote speakers from the event, downloadable presentations, and a blog from Senior Fellow Ruth Thorlby are available to access via the dedicated event page.  

The Nuffield Trust subsequently published a research summary: Managing health reform through an economic downturn (October 2011), based on the presentations and discussions held at the seminar, which suggests that implementing cost-saving measures requires skilful political leadership and honesty with the public about the need for budget cuts.  The full report and downloadable slidepack are available to access from the ‘Project outputs’ on the right-hand side of this page.

In 2010, we undertook a study tour (in collaboration with NHS North West and the Manchester Business School), held a seminar and published a report with the aim of sharing the lessons from the work of Techniker Krankenkasse, one of Germany’s largest statutory health insurance companies, based in Hamburg, and the wider German health care system.

The German health care system is a high-performing one, where recent policy reforms have attempted to contain costs and strengthen competition. With recent policy proposing the formation of a national commissioning board for England, the Nuffield Trust and colleagues were interested to learn how a statutory not-for-profit national insurer in Germany was managing to achieve better value health care in an economically challenging environment.

Project outputs

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