Insider tales and must-read analysis on how integration is reshaping health and care systems, NHS providers, primary care, and commissioning. This week by deputy editor Dave West.
The centre managed to keep implementation guidance for the NHS long-term plan reasonably concise, but still seems to be persisting with two mistakes of the 2016 sustainability and transformation plan process.
One was to require systems – explicitly or implicitly – to sign up to a range of improvements, notably in reduction of waiting times and waiting lists; even in the full knowledge this was totally unrealistic (as they quickly proved).
Unfortunately, many areas report this request is now being repeated in the current five-year planning process, with doomed commitments and multiple accompanying templates having to be populated by September.
Today, the new prime minister Boris Johnson repeated to the Commons his desire for improvements on the ”front line”, and said he had already asked NHS officials for urgent plans to reduce waiting times with a particular focus on GP appointments.
Conveniently enough, this is more or less exactly what officials are already producing right now in their system long-term plans (and indeed, have sought to do in pretty much every year for some time).
Undoubtedly it can all be used as a political chip – particularly to press the new administration for the capital investment in diagnostic capacity (and some shiny new buildings), and cash for training to try to bolster GP and nursing numbers, also necessary to try to dent the access problems.
Early and very vague indications are Mr Johnson may be keen to announce dollops of NHS capital (“20 hospital upgrades”) and perhaps education/training spend; while Simon Stevens is well positioned and of course very able to drive the point home.
The case from the NHS, now repeated in government but far from fully worked through, is these asks (and some others, ideally) need to be met if voters are to see “front line” improvement. For the government, spending on hospitals can also secure MPs’ support in crucial Commons votes.
But, for the NHS locally, quickly reproducing plans which are doomed to just fail again will, as it did in 2016, have costs.
One such cost is the disappointment and shaken confidence that follows. The politicians will likely continue, when they can get away with it, leaving the NHS itself to answer for its performance problems.
Worse though is the damage to the cause of developing genuine plans whose authors actually believe in and follow them.
If systems need to produce unrealistic proformas in the autumn, they also need to run a separate and much more prominent process, on their own timetable, to develop their own actual plan, for their own genuine priorities.
Most of the areas which have more successfully built confidence (Dorset and Greater Manchester, for example) took this approach early, managing to navigate around national rules.
But as in 2016 – and the second mistake which is being repeated – is the majority of systems still feel they are not allowed, or not able, to follow this path, and they will experience similar problems again.
HSJ’s Integrated Care Summit 2019, on 19-20 September in Manchester. It is open to senior leaders in relevant roles and sectors.
The HSJ Integrated Care Summit, taking place at the Hilton Deansgate, Manchester from 19-20 September, unites 150+ senior leaders from across the provider, commissioning and local council landscape to determine how to best capitalise on the new funding settlement to rethink service delivery to improve quality and outcomes for your local population.
Held under the Chatham House Rule, attendees will quiz Simon Stevens, Rosie Benneyworth and other national figures on general policy direction, and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The Summit is free to attend for senior NHS and public sector figures – register your interest here: https://integratedcare.hsj.co.uk/register-2019