How Healthcare Can be Saved (FT Press Delivers Elements)


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From , population health management tools will be rolled out, enabling ICSs to identify groups at risk of adverse health outcomes and inequalities and to plan services accordingly. ICSs will also be supported by changes to funding flows and performance frameworks.

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Existing approaches to bringing together health and social care budgets are also encouraged, with an expectation that the social care Green Paper will set out further proposals. There will also be a review of the Better Care Fund. The plan suggests that progress can continue to be made within the current legislative framework but also puts forward a list of potential legislative changes that would accelerate progress, in response to requests from the Health and Social Care Select Committee and the government.

The proposed changes include allowing joint decision-making between providers and commissioners and reducing the role of competition in the NHS.

There are also plans to introduce new programmes for specific diseases and conditions, and to scale up existing ones. For example, the number of places on the Diabetes Prevention Programme will double over the next five years. ICSs will have a key role in helping to deliver these programmes and in working with local authorities, the voluntary sector and other local partners to improve population health and tackle the wider determinants of ill health.

Spending in these areas is not covered by the plan as it is routed through local authorities. To support this ambition and to ensure that local plans and national programmes are focused on reducing inequalities, specific, measurable goals will be set. Local areas will need to set out how they will achieve this, drawing on a menu of evidence-based interventions developed by NHS England, Public Health England and others.

Changes to commissioning allocations for CCGs will ensure that a higher share of funding is targeted at areas with high inequalities and a review of the inequalities adjustment to funding formulae will be undertaken. The plan includes specific goals for particular groups — for example, greater continuity of midwife care for black, Asian and minority ethnic women and women from deprived groups; an increase in physical health checks for people with severe mental health. Further detail on how the commitments in the long-term plan will be implemented will be set out in a national implementation framework, due to be published in spring However, there are a number of other plans and reviews will have an impact on how the plan is implemented.

These include the following:. The Spending Review will outline funding for areas of NHS spending not covered by the plan such as workforce training and capital investment, as well as for social care and local authority-funded public health services. The social care Green Paper is expected to set out options for social care funding and proposals for health and social care integration.

The prevention Green Paper, also expected in , will focus on delivering the vision for prevention published in November Overall, the long-term plan amounts to an ambitious set of commitments within the constraints of the funding available. It is firmly focused on the future, rather than simply shoring up current models of care, and sets the right direction for the NHS by focusing on delivering joined-up, personalised, preventive care, and expanding primary and community services.

In many respects, the plan signals continuity rather than change. Many of the chosen clinical priorities, including mental health and primary and community services, have also been singled out for attention in recent years. This reflects a constancy of purpose that has often been missing in health policy and should allow the NHS to build on recent progress. Although the level of detail in the plan is variable, it differs from the Forward View by focusing more on delivery and implementation.


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There are measures to accelerate progress towards integrated care, for example by aligning regulation and providing funding for primary and community care. It signals a shift in gear from the bottom-up, iterative approach that followed the Forward View, while retaining a balance between national prescription and local autonomy.


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  • However, there is now no doubt that the NHS is moving rapidly away from the focus on organisational autonomy and competition that characterised the Lansley reforms. There are some notable omissions from the plan.

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    Multi-morbidity is barely mentioned despite the growing number of people living with multiple long-term conditions. In contrast to the Forward View, the plan is relatively silent on how the NHS will work with communities and engage patients and the public in shaping services. Also significant is the absence of any commitments to current waiting time targets - these are on hold until the clinical review of standards is published later in the year.

    The ambition to deliver more personalised, joined-up and proactive care — if it can be delivered — could make a significant difference to patients and change how they interact with health services. Potential benefits include: fewer handoffs and referrals for patients receiving care in the community; more NHS support for people in care homes; better access to services spanning mental health, general practice and community crisis response teams; fewer trips to outpatient appointments; more services and information available online; and more opportunities for people to make decisions about their own care.

    By assuming that demand for acute services will continue to increase at roughly its current rate, the plan provides a welcome dose of realism and avoids the mistake made in predecessor plans of assuming that strengthening primary and community services will result in reduced demand for hospital care. Changes to acute services include significant reforms to urgent and emergency care, a major overhaul of outpatient services, more hospitals splitting services between hot and cold sites, further consolidation of stroke services and possible changes to service configurations if more hospitals take up the green light to merge.

    Taken together, this adds up to an ambitious agenda for change that could provide significant benefits for patients. Delivering it will require skilful leadership and a concerted effort to involve patients and communities. A consistent lesson from previous attempts at NHS reform is that central directives on their own often fail to deliver the improvements envisaged.

    To overcome this, the approach to delivering the plan balances national direction with local autonomy. At the same time, the plan promises that local implementation will be led by clinicians and leaders who are directly accountable for patient care. This means that much is riding on the ability of local systems to deliver. ICSs are singled out as being central to the delivery of the plan. However, their development is currently much more advanced in some areas than others, and even the most advanced systems are in their early stages.

    ICSs have no formal powers or accountabilities the plan does not suggest any change to this and progress is dependent on the willingness of individuals and strength of local relationships. There are also high expectations on primary care networks as the key mechanism for delivering the expansion in primary and community services outlined in the plan. However, these are a long way from existing in the form or on the scale envisaged.

    Providing support for ICSs and primary care networks and building local leadership capacity and capability should therefore be key priorities. National bodies have an important role in removing barriers to local implementation. This will also need to be reflected in the behaviours of regulators on the ground. The potential changes to the legislative framework also seek to remove barriers and accelerate change but the prospect of parliament passing new legislation remains unlikely in the short term.

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    The Importance of Continuous Education in Healthcare

    In the meantime, the plan is right to stress that the immediate priority is to continue making progress within existing legislation. NHS leaders have done what was asked of them by delivering a forward-thinking plan that sets out how the NHS will spend the additional money promised by the government. It is essential to view the plan within this context, and to recognise its limitations. Critical interdependencies exist between the NHS and local government, wider public services and communities. A plan for the NHS cannot fully address this wider context, particularly when there is so much uncertainty about the future of social care and public health budgets are being cut.

    The decision to delay publication of the social care Green Paper is a missed opportunity to tackle the issues facing and health and social care in a joined-up way. However, the funding settlement for social care will not be known until the Spending Review later this year.

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    The commitment of the NHS to play its part in improving prevention and reducing health inequalities should be applauded but these aims cannot be achieved by the NHS in isolation. Partnerships between the NHS and local government will be key to delivering improvements in population health. ICSs should ensure that local authorities are equal partners and engage with the voluntary sector, patients and communities.

    This should include reversing cuts to public health budgets and being bolder about using other mechanisms at their disposal including tax and regulation to drive improvements in population health. The long-term plan marks a significant step forward in setting the NHS on a sustainable course for the next decade. The main challenge will be to translate this into delivery. Even with exceptional leadership and the continued commitment of staff, delivering the extensive list of commitments outlined in the plan is a daunting task.

    While the funding settlement is a significant improvement on the constraints of recent years, it is not a panacea. The NHS will continue to face tough choices about how to prioritise resources. One of the most important of these decisions — what to do about recovering waiting times standards — has been postponed. Patients are likely to continue to face longer waits for treatment for the foreseeable future. The greatest risk to delivery is workforce shortages.

    Put simply, the NHS will not be able to achieve its ambitions if it does not have the number and type of staff that it needs. Much is now riding on the workforce implementation plan due later this year.

    NHS England » Working to deliver the care mental health patients deserve

    While the long-term plan is an important piece of the jigsaw, the picture is far from complete. With thanks to the policy leads and other colleagues for their contribution to this explainer. As you comment the plan has little to say about arguably the biggest problem the NHS faces- multimorbidity, especially in the elderly. This needs truly integrated medical psychiatric and social care. Treating 'mental health' seperately from 'physical health' is a major missed opportunity.

    I do wonder why the plan makes patients wait until to have a "right" to digital access to their GP. We're doing it now, over half of episodes now starting digitally.

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    And in any case, patients have been able to order repeat prescriptions, see their records and allegedly book appointments online for some years now. It hasn't worked, and rather than print more vague promises, NHS England would do better to understand why it hasn't worked. We'll tell them for nothing if they ask.

    As highlighted by the King's Fund and others the biggest single problem is clinical staff shortage. The government seems to think that this can be overcome by 'technology'. It can not. Until politicians recognise that they have caused this problem it is never going to improve. If staff feel valued and their working conditions are satisfactory they will be recruited and retained.

    It is a plan with great prospect. However, it is astonishing that education is not part of this "forward-looking" vision that merely seems to lay the foundation for a theoretical paradigm.


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    • Education should not be reduced to the mere dissemination of information. Rather, its overarching goal is to support learners in the process of being taken out of what they already believe they know in order to be led into one of newfound realization, whilst simultaneously making them aware of their learning journey to allow for knowledge crystallization.

      This process prevents patients and staff to mindlessly go through the motions just for being told to do so. I appreciate the size of the task for the NHS cohort, but if things are to start improving and working well again in this country we need to approach challenges like we mean business as it is obtainable in other progressive, none- English speaking European nations where they really contemplate problems critically and come up with workable solutions instead of just mere posturing and waiting for a pat on the shoulders for fair attempt.

      Perhaps, it is the language, and they spend more emphasis on colourful, high -sounding, intelligent and cooperate words and terms that signify or do not amount to much to the ordinary man on street. Perhaps this is how they win their contracts, so that year on year, you have the same or similar group of old boys and girls being commissioned to review high profile situations with big promises and short on delivery, waste of public fund, waste of time. If they do, they will soon realize why some of their ideas are not working or will just not plug the holes.

      Let me be clear, placement is good but my goodness, does the government realize the difficulties most student face whilst in placement? A majority of students on placement are disillusioned about the profession by the time they complete their placement. This is not because the placement is hard but because it has been made unpleasant due to the attitude of qualified staff and leadership in the ward hence students fail or quit the profession altogether. The government should be spending more time trying to find out why such a high drop out rate for nursing students and newly qualified nurses and how to support them and make their working environment suitable so that students want to stay, when student stay it leads to more qualified nurses and this in turn makes the profession more attractive, word of mouth more people taking up the profession, less dependency on foreign nurses, less money spent on foreign recruitment and retraining for nurse recruits.

      The other point is about digitalization in care.

      How Healthcare Can be Saved (FT Press Delivers Elements) How Healthcare Can be Saved (FT Press Delivers Elements)
      How Healthcare Can be Saved (FT Press Delivers Elements) How Healthcare Can be Saved (FT Press Delivers Elements)
      How Healthcare Can be Saved (FT Press Delivers Elements) How Healthcare Can be Saved (FT Press Delivers Elements)
      How Healthcare Can be Saved (FT Press Delivers Elements) How Healthcare Can be Saved (FT Press Delivers Elements)
      How Healthcare Can be Saved (FT Press Delivers Elements) How Healthcare Can be Saved (FT Press Delivers Elements)

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