Transforming services for patients

The population’s health needs have changed dramatically since the NHS was established in 1948. People are living longer, healthier lives; huge progress has been made in reducing premature deaths from leading causes such as heart disease, stroke and cancer.

However, the NHS has not kept pace with 65 years of demographic, social and technological change and is still largely based on the post-war model of providing episodic treatment in hospitals. It remains a service that diagnoses and treats sickness, instead of one that predicts and prevents it.

Fundamental change is needed to respond to the needs of the ageing population, the changing burden of disease and rising patient expectations. This should be based on moving more care out of hospitals into the community and focusing more on prevention. Change needs to be supported by a long-term commitment to improving the population’s health, with local authorities using their new responsibilities for public health to lead the way locally, supported by government regulation where necessary. Priorities include tackling obesity, reducing alcohol-related health problems and addressing persistent inequalities in health between rich and poor.

Integrated care delivered at scale and pace

Meeting the needs of the ageing population and the growing number of people with long-term conditions requires services to work much more closely together to provide care co-ordinated around the needs of the individual. This means overcoming barriers between primary and secondary care, physical and mental health, and health and social care to provide integrated care. Experience from the United Kingdom and around the world shows that integrated care improves health outcomes and patient experience, and offers opportunities to improve efficiency. Delivering it should become the core business of everyone working in health and social care.

Although there is now political consensus about the benefits of integrated care and progress has been made through local initiatives and pilot schemes, implementation remains patchy. The challenge now is to convert good intentions into meaningful and widespread change on the ground. To deliver integrated care at scale and pace, the next government should focus on removing the barriers to its implementation. This should include addressing the fragmentation of commissioning, tackling perverse financial incentives in the way that services are paid for, and ensuring the application of competition policy does not hinder collaboration between services.

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A new deal for general practice

General practice is under huge pressure due to rising demand from patients at a time when its share of NHS funding is declining. There are significant variations in the quality of care provided by GPs, and many surgeries are struggling to meet demand for appointments. Still organised largely on the basis of small independent practices providing a limited range of services, general practice is unable to operate at sufficient scale to meet demand from patients.

GPs need to work differently – as some are already doing – by forming federations to work together and provide a wider range of services for their patients. This way of working should be extended, with GPs responsible for leading ‘family care networks,’ which bring together health and care professionals to provide all but the most specialist care outside hospitals. To facilitate this, the next government should develop a new type of contract to enable federations of practices to take on responsibility for delivering more services to larger numbers of patients. This would offer an opportunity for GPs to lead the development of local services and bring more money into their practices.

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Political backing for service changes

Major hospital services reorganisations are needed to improve quality of care and increase financial sustainability. Lives can be saved by concentrating some specialist services in fewer centres of excellence, which bring together the best doctors to deal with high volumes of cases, 24 hours a day. However, progress in reorganising services has been slow and hampered by high-profile setbacks such as the failure to conclude the long-running review of children’s heart surgery after more than a decade.

Concerted action is needed to increase the concentration of specialist services where there is evidence that this improves outcomes. Other services would continue to be provided locally by smaller hospitals working together in networks, rather than on the basis that they all provide a full range of services. Some of the changes resulting from this are likely to be contested by local communities. The government and local politicians must be much braver in supporting changes to services where there is a clear case for change. The next government will have a window of opportunity early in the next parliament to drive through the changes needed – this is an opportunity it must seize.

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