Fixing the broken system
NHS performance has improved greatly over the past decade.
NHS performance has improved greatly over the past decade. Despite this, like healthcare systems in other countries, it is struggling to meet the needs of an ageing population and the increasing prevalence of long term conditions. Urgent action is needed to change how health and social care are delivered to make them fit for the future.
This is the bold claim of a new paper, Transforming Health and Care, from The King’s Fund, which makes the case for fundamentally reforming how care is provided to patients and users. Evidence summarised in the paper highlights weaknesses in all areas of the current system. For example, international surveys show the NHS often performs poorly compared with other countries on patient experience.
The Care Quality Commission has demonstrated shortcomings in the care of older people, including failures to maintain appropriate standards of dignity and nutrition. Too many older people are treated in hospitals and care homes because of the lack of suitable alternatives, including at the end of life. Our analysis highlights the need to strengthen prevention, provide more consistent standards of primary care, and concentrate some specialist services to deliver better outcomes.
Several well-known drivers of change will profoundly increase demand for care and accentuate the current system’s weaknesses. First, the ageing population - especially the growing number of people aged 85 and over - will place increasing demands on services that are already struggling to cope with the needs of this age group.
Second, the changing burden of disease, most notably the increased prevalence of long term conditions, will underline the challenges of providing high-quality care in the currenty fragmented system. This applies above all to people with more than one long term condition, as evidence shows that multiple morbidities are now the rule, rather than the exception.
Third, ever rising patient and public expectations mean that users will not tolerate care that is unresponsive to their needs. The retiring baby boomer generation, as well as younger people, will demand rapid access to services that treat them as individuals and matches experience in other sectors.
Incremental improvements to existing service models will not be sufficient to address these weaknesses. A much bolder response is required, involving fundamental changes to how health and social care are delivered.
Although these arguments have been advanced before, they have not been heeded and time is running out to make the changes that are urgently needed.
Models of care that were established to meet the needs of the post-war population should be superseded by new approaches with the following characteristics. Patients and service users should be part of the care team and involved in the co-design and co-production of care, and health and social care staff should work flexibly in teams, making full use of the range of skills available.
Care needs to be provided in the right place at the right time with less reliance on hospitals and care homes, and with much greater integration around the needs of patients and users.
In addition, information and communication technologies, such as smartphones, email and the internet, need to be harnessed as they have the ability to transform patients’ and users’ experiences.
Breakthroughs in medical technologies have the potential to bring benefits to patients where these are supported by evidence of cost-effectiveness, and data and information must be used to support patients and health professionals to deliver high-quality care every time.
The argument for fundamental change is based on long-standing weaknesses in current service models, but is reinforced by the prospect of a decade of austerity in public services. These services sit on a burning financial platform and this provides an opportunity to make overdue changes to how care is delivered.
If this opportunity is to be seized, national and local leaders must move beyond the distraction of the Health and Social Care Act, and the massive organisational changes precipitated by it, and focus on improving services. They should give priority to decommissioning outmoded models of care, supporting innovation, and opening up the market to new entrants where appropriate. Politicians must play their part by supporting risk taking to enable change to happen at the scale and pace now needed.
The King’s Fund’s new programme of work is designed to stimulate fresh thinking on the models of care required in the future and what needs to happen to put them in place. We hope HSJ readers will join us in debating these ideas and taking action to redesign services for the communities they serve.
Chris Ham is chief executive and Anna Dixon is director of policy at The King’s Fund.