Great Expectations: Achieving a sustainable health system

It has long been understood that rising public expectations are one of the main cost pressures on the health service. This study assess how policymakers can reconcile high and rising public expectations with the need for a health system that is financially and politically sustainable.

High expectations are not a bad thing. Both as taxpayers and service users, it is right and necessary that the public has high expectations about what public services can deliver. The public's expectations play a vital role in holding politicians and providers to account and maintaining momentum for progress and improvement. However, when expectations become unrealistic, this creates problems for the service. This is because expectations, often refracted though the media, can drive the health system in inappropriate ways.

In this report we assess expectations as one of a number of cost pressures on the NHS. Particularly, we assess how, since 1997, the Labour Government has attempted to meet expectations through reform and increased funding but has simultaneously raised people's expectations.

With the NHS turning sixty in 2008 and rates of spending growth set to slow significantly, this is a timely moment to revisit the service's aims and objectives.

We argue that while there is no sudden move to NHS independence, there should be a move to geater local accountability, including Foundation Primary Care Trusts being established.

There should be greater political and public recognition about the limits to the NHS, including the existence and need for rationing, and an expanded role for NICE allowing it to assess all new treatments and drugs for cost efficacy within a reasonable timeframe.