Simon Stevens, Chief Executive of NHS England, added his voice to those arguing for realism in recent evidence to the Health and Social Care Committee when he told MPs that there was a need to ‘phase improvement’. Underlying Stevens’ caution and that of other stakeholders is an acute awareness of the depths of current challenges and the growing shortages of staff that need to be tackled to get the NHS back on track and deliver further improvements in care. Ian Dalton, Chief Executive of NHS Improvement, told MPs in his evidence that the immediate priority was to deal with providers’ deficits, and then earmark funds for transformation.
We agree that tough choices face NHS leaders and staff and that realism is needed about the time it will take to recover lost ground. Our worry is that giving priority to sustainability ahead of transformation is unhelpful when transformation holds the key to the long-term sustainability of the NHS. If five years of funding increases simply restore the NHS to levels of performance last seen in 2012/13 and shore up hospital-centred models that are no longer fit for purpose, then a huge opportunity will have been missed.
That is why we are calling today for the NHS plan to outline realistic ambitions to transform health and care over the next decade that the NHS and its partners can unite behind. The centrepiece of the plan should be a commitment to bring about measurable improvements in population health and to reduce health inequalities. Action is required across government to improve outcomes for patients by giving greater priority to prevention and to tackling the wider determinants of health and wellbeing. The NHS has a key part to play alongside legislation and regulation, leadership by local authorities, and the involvement of people and communities.
Improving health and reducing health inequalities depends on making further progress in integrating health and social care, building on the development of new care models, sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). Crucially, additional funding should be earmarked from 2019/20 onwards to support the further development of integrated care with a focus on the needs of older people with frailty, people with complex needs and children.
There is much the NHS can learn from the work of Wigan Council and its partners on how to lead transformation during austerity, as I learnt on a recent visit. At a time of deep cuts in local government spending, difficult decisions have been made about the services that can be provided, with an emphasis on reducing demand for care and support by working differently with residents. Conversations with the public have helped to identify more effective forms of care and these are often delivered at lower cost.
Emerging evidence shows that population health outcomes are improving with reductions in premature deaths from heart disease and cancer, smoking rates, and suicides. The council has also kept Council Tax low while making cuts in spending and finding resources to invest in community groups and services. The emphasis is placed on working with people – not doing things to them – with the aim of reducing dependency and supporting communities to become stronger and more resilient.
Learning from Wigan, the NHS and its partners must work closely with people and communities, understanding what matters to them and supporting people to take more control of their health and wellbeing. A new deal with the public should recognise what people themselves can contribute and their responsibilities in making healthy choices and using services appropriately. This is best done locally, based on a deep understanding of communities and a partnership between local services, service users and citizens.
As work on the 10-year plan gets under way, ambition must be joined with realism and transformation with sustainability. The NHS and its partners should look at all their assets and not just the increases that have been promised. Framing the ambition around improving population health and a new deal with the public offers the best opportunity for the future.
It is as ever a thoughtful and balanced piece. There are for me two major missing parts.
1) How we create a joined up system that supports action on all those things that lie outside the health system but make such a big difference to health. Surely some 'health' money needs to spent there as well.
2) How we counteract those businesses and industries and processes which are health damaging.