There are many reasons to be cautious about whether the long-term plan can be delivered but there is hope that the NHS can rise to the challenge it has been set, writes Chris Ham
The science fiction writer, William Gibson, could have been thinking of the NHS when he wrote that ”the future already exists, it’s just not evenly distributed”. As the long-term plan points out, many of its ambitions are both credible and deliverable because they are already in place somewhere. I’ve seen plenty of evidence in my work across the NHS.
Take outpatient services as an example. The development of e-clinics in Tower Hamlets for patients with chronic kidney disease enables GPs to seek specialist advice remotely. The number of outpatient appointments has fallen by half and waiting times have been cut from 64 days to an average of five days.
In primary care, the plan promises to make it easier for patients to seek advice without the need for a face to face consultation
Another example is care home provision where the plan cites the experience of Nottinghamshire. By providing general practice support to care homes, the vanguard has cut accident and emergency attendances and emergency hospital admissions by around a quarter. The plan promises to roll out this model of care over the next decade.
Within hospitals, the future can be seen in the way in which some trusts have implemented same day emergency care. By assessing and discharging patients rather than admitting them to hospital, priority can be given to patients who need to be admitted for a medical emergency or because of an urgent need for a planned procedure. The widespread adoption of same day emergency care is expected to increase the proportion of patients discharged on the day of attendance from a quarter to a third.
In primary care, the plan promises to make it easier for patients to seek advice without the need for a face to face consultation. The commitment to ”digital first primary care” builds on what is happening in many areas to offer patients the option of telephone and online consultations to reduce waiting and travelling where appropriate. Over the next five years patients will have the right to choose this option either from their own practice or from one of the new digital providers.
The plan also makes a welcome commitment to quality improvement as one of the means that will be used to make a reality of its ambitions
Patients will also be given more control over their care by the expansion of personalised care. The ambitions here include making personal health budgets available to 200,000 people, compared with 32,000 currently, and supporting people to manage their own conditions through digital training programmes. Personalised care planning, including for people nearing the end of their lives, is another priority.
In mental health, the plan emphasises the need to provide effective community-based crisis response services in every area. This includes alternatives to A&E such as safe havens and crisis cafes, and I saw an impressive example on a recent visit to Gloucester. The plan includes a commitment to expand the coverage of these alternatives.
Last but not least, preventative services of proven benefit will be made more widely available. Examples include expanding the provision of breath tests to assess lung cancer risk based on work in Liverpool and Manchester and offering pulmonary rehabilitation for people with COPD and breathlessness. Rolling out diabetes prevention programmes through the use of digital technologies is another priority.
Nye Bevan spoke about “universalising the best” in debates on the founding of the NHS and his aspiration remains as relevant today as it was then. How then can the NHS move from pockets of innovation and good practice to adopt more systematically the improvements in health and care that are within reach with the additional resources the government has committed?
Part of the answer is to work more collaboratively by building on the foundations laid by sustainability and transformation partnerships and integrated care systems. All areas of England will be covered by ICSs by 2021 and it is expected that these systems will use their resources for the benefit of their populations. Successful organisations will be required to support those who may be struggling underpinned by a duty to collaborate and with “mutual aid” as the watchword.
The plan also makes a welcome commitment to quality improvement as one of the means that will be used to make a reality of its ambitions. An increasing number of NHS organisations have developed capabilities in quality improvement and this lies behind impressive improvements in performance in some areas. A notable example is the work done by the Western Sussex Hospitals Foundation Trust to support Brighton and Sussex Trust to move from inadequate to good.
A key lesson from the implementation of the Five year forward view is that frontline staff will lead innovations in care when they have the time and support to do so. Leaders must now identify the resources to enable this to happen everywhere drawing on the intrinsic motivation of staff to provide the best possible care. For their part, the regulators must moderate their demands on providers and commissioners to create headroom for innovation.
There are many reasons to be cautious about whether the plan can be delivered, including staff shortages and uncertainty about the future of social care and public health funding. But the fact that many of the plan’s ambitions already exist offers hope that the NHS can rise to the challenge it has been set.
- BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST
- Emergency care
- Integrated care
- Mental health
- NHS long term plan
- NHS Tower Hamlets CCG
- Personal health budgets
- Policy and regulation
- Primary care
- Sustainability and transformation plans (STPs)
- WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST