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2019: handling the uncertainty


An NHS long-term plan, a social care Green Paper, a prevention Green Paper. And somewhere woven in amongst all that, Brexit. Or possibly not Brexit, depending on how the politics plays out.

At the same time staff in the newly aligned NHS England and NHS Improvement will be settling into post, not least in the newly restructured regions – this alignment ends well over a decade of separation, remembering that Monitor existed long before the Health and Social Care Act 2012. Of course, on a bigger scale, the whole NHS is moving from competition to co-operation despite the legislative framework. Meanwhile across the country we expect sustainability and transformation partnerships to continue the journey towards integrated care systems with an added dose of primary care networks on top.

This all seems to fall into one of two buckets. The first is a continuation of reform and structural change (even if not the classic 'top-down' reorganisation so disliked by everyone). The second is a collection of issues just too uncertain to guess, especially from the perspective of 2 January. Depending on your personality type, a mix of organisational change and deep uncertainty is probably not the most positive of rallying calls especially if you read this while many in the NHS are already busy trying to avoid another winter crisis. But there are some things about 2019 that should give more hope.

Firstly, the government clearly recognised the depth of the financial challenge facing the NHS when it committed to its 3.4 per cent a year real-terms growth, even if this is still below the long-term average for NHS funding growth. In that vein, I hope 2019 will see the government similarly grasp the nettle of a funding solution for social care. While that may be optimistic, I do think that the penny is dropping across both national NHS leaders and Whitehall that both health and social care are in a deep workforce crisis and that urgent action is needed. Unfortunately, this crisis will be harder to overcome than the funding challenge but admitting there is a problem is the first step towards beating it.

Secondly, putting all the organisational and governance change to one side for a moment, the direction of travel towards more integrated care and towards population health – which aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population – is a prize worth the effort. Yes, this change – at least on population health – is still in its relative infancy. And, yes, there remains so much to be done, whether in getting clinical engagement or in working out the terms of trade between local government, without whom there can be no meaningful approach to improving population health, and the NHS. But the recognition that no one sector can tackle health inequalities and improve outcomes (and on the flip side, cannot stop the rising tide of demand either) without a focus on the fundamental causes of ill health alongside high quality health services must be a good thing.

To navel gaze for just a moment, like many others we will be considering our own response to these challenges and opportunities. In 2019 The King’s Fund will refresh its own five-year strategy and we will kick off a round of engagement to take views on where we can best leverage our resources to improve health and care. At the moment, working on practical steps to support population health, including the leadership challenges it presents, looks key. Also early in the year we will publish jointly with colleagues in the Nuffield Trust and the Health Foundation a report focusing on potential solutions to the workforce crisis. But like so many others, part of the response to 2019 will be maintaining flexibility as ‘events’ play out over the year – the one certainty is uncertainty.