Comment Blog 21 March, 2017

How soon is now?

I wanted to give a bit more space to the themes of our health conference on 9 March, which I touched on last week.

One of the sharpest ideas raised by the conference was that people have been talking about the same ideas in regard to NHS reform since the early days of the Blair Government, yet progress has been “painfully slow”.  I thought I would quickly review one or two of the key policy documents to assess the truth of this.

The most important document of all was the NHS Plan, published in the year 2000, which set the direction for all of the remaining Blair years. This did indeed include a number of the key themes of the Five Year Forward View.  Summarising quickly here:

  • Prevention (“The NHS will focus efforts on preventing, as well as treating ill-health. Recognising that good health also depends upon social, environmental and economic factors such as deprivation, housing, education and nutrition, the NHS will work with other public services to intervene not just after but before ill health occurs.”)
  • Integration of health and social care (“For the first time social services and the NHS will come together with new agreements to pool resources. There will be new Care Trusts to commission health and social care in a single organisation. This will help prevent patients – particularly old people – falling in the cracks between the two services or being left in hospital when they could be safely in their own home.”)
  • Patient safety, which was Jeremy Hunt’s key theme (“All those providing care will work to make it ever safer, and support a culture where we can learn from and effectively reduce mistakes.”).

Lord Darzi’s review, published in 2008, echoed the ideas on prevention. It also made exactly the arguments that have been set out for STPs i.e. that local health regions should draw up reform plans together, and indeed that local areas should “communicate clearly throughout” because “changing well-loved services can be unsettling for patients, public and staff).

This is not to say that there has been zero progress. David Mowat MP, the Care Minister, rightly pointed last week to the fast development of larger GP practices covering much bigger populations (full Reform report on primary care here).

Still, it has to be asked why the NHS has been talking about a basic change in direction rather than doing it, and for so many years. For me, this remains the key problem with the Chancellor’s Budget approach. The Treasury is in a great position to ask the NHS why it hasn’t delivered on its oft-repeated plans. In fact, it has to do it, since so much of the Service’s financial problems are tied up with the lack of change.

The recently published “Plan for Britain” is no better, promising, as it does, only to “continue to invest in the NHS to help people at every stage of their life and support a vital national institution”.

The Reform health conference brought forward specific ideas to make change happen. For providers, the 250 English NHS hospitals should be brought together into 60 or so chains, and 7,800 GP practices into hundreds of super-practices. These providers would answer to a smaller number of commissioners, most naturally one in each of the 44 Sustainability and Transformation Plan areas. Those commissioners would pay by outcomes and capitation, not payment by hospital activity. It is the delivery of these ideas for which the Government should be accountable, including the Chancellor and Prime Minister.