Looking beyond the NHS Long Term Plan headlines to deliver ‘better health, for life’
“Theresa May reveals plans to open gambling addiction clinics in NHS shake-up”
“New mothers and fathers will be offered mental health support for two years after their child is born under Theresa May's NHS plan”
“NHS long-term plan promises digital GP appointments for all”
Just three of the headlines heralding last month’s publication of the NHS Long Term Plan, our side of the deal to match the Government’s commitment of funding increases averaging 3.4 per cent over the next five years, compared with 2.2 per cent over the past five years earlier this month.
The media coverage might lead you to think the plan represents a disparate mix of popular policy commitments. You might also assume there are no major implications for acute and specialist hospitals like ours.
However, if you read the plan’s 130 plus pages, you will find a pretty clear and coherent direction of travel for the whole of the NHS as well as a taster of the legislative changes and new incentives, targets and opportunities that are being developed to get it implemented. As many commentators have noted, there are some gaps, around plans for workforce development, social care and capital investment in particular. A question mark also remains over whether or not the funding increases will be enough to respond to rising demand and changing needs. But the vision set out in the plan is both pragmatic and transformational, seeking to address the root causes of the NHS’s challenges, and there is much for us to consider.
Looking at the implications for our organisation, and for what we are seeking to achieve for our communities, patients and staff, six key themes emerge:
Collaboration not competition
While specific organisational changes are carefully avoided, the intention is clear – there’s an acceleration of the move away from the NHS purchaser-provider split and towards area-based planning and much closer collaboration between providers.
There is a commitment to have integrated care systems (ICSs) in place everywhere across England by 2021: “ICSs will have a key role in working with local authorities at ‘place’ level and, through ICSs, commissioners will make shared decisions with providers on how to use resources, design services and improve population health … Every ICS will need streamlined commissioning arrangements to enable a single set of commissioning decisions at system level…CCGs will become leaner, more strategic organisations that support providers to partner with local government and other community organisations on population health, service redesign and Long Term Plan implementation.”
There isn’t much detail yet but I find it encouraging that the focus is on building relationships – between organisations and individuals to join up planning and services – rather than top down structural changes. The plan indicates a raft of new options for organisation form and regulations to support this approach.
We’ve already seen the value of this style of working ourselves. From its foundation in 2016, the Hammersmith and Fulham Integrated Care Partnership has been a ‘ground-up’ response to developing more person-centred pathways of care. We have learnt with our partners as we have gone along, seeking to get on and try out changes in practice. Connecting Care for Children – highlighted in the NHS Long Term Plan as best practice – evolved out of our paediatricians and local GPs looking to learn from each other and to work together to do the best for children and their families. And our growing collaboration with Chelsea and Westminster is highlighting opportunities for co-designing care pathways that are better for patients and staff and cost less money. A recent example is our joint plan for an integrated children’s hospital network for north west London brought forward as part of a wider response to potential changes at the Royal Brompton and Harefield NHS Foundation Trust.
A funding – as well as a policy – shift towards community and primary care
The plan makes a commitment that funding for primary medical and community services will grow faster than the overall NHS budget. On a superficial level this can be seen as diverting resources away from other parts of the NHS but the real picture is far more nuanced. Better access to care locally will make a big difference to the lives of our patients and local communities. And that doesn’t just mean more traditional primary and community care services but also greater local access to the wealth of specialist expertise and support we offer. As already noted, we’re doing this now with some services in some places, despite the NHS’s existing financial structures often acting as disincentive; the plan is an opportunity to bring these pockets of innovation into the mainstream. Helping our communities to stay healthier at or near to home also has the benefit of reducing what feels like the relentless pressure on our urgent and emergency services.
Huge ambition for digital services and use of data
A lot has been trailed over the years about getting the same level of digitalisation in the NHS as we take for granted in other aspects of our lives, but the pace has often been frustratingly slow. The plan has some welcome developments to help make the leap: a new NHS app, a big ambition for virtual services and a step change in patient access to information. As one of the 16 NHS global digital exemplars, we are already well placed to make the most of these opportunities.
The single electronic patient record system across all of our hospitals – and, soon, all of Chelsea and Westminster’s – offers enormous potential. The sepsis alert within our system helping us reduce the time it takes to start antibiotics; the new Streams app allowing our clinicians real-time access to pathology and radiology tests on mobile devices; and our emerging research focus on analysing the huge wealth of patient data we have gathered in order to identify new insights and better treatments: these are all real world examples of the vision for digital set out in the plan. The care information exchange - the online portal we developed with funding from Imperial Health Charity to give patients and their clinicians access to their medical records and a secure communication route – is having an even wider impact for the 23,000 plus patients across north west London who are already using it.
Greater NHS responsibility for tackling health inequalities and preventing disease
Funding is rightly being rebalanced to areas of the country with the greatest health inequalities but the whole of the NHS is being urged – and incentivised – to take more responsibility for improving and maintaining the health of our communities. The plan encourages NHS organisations like ours to develop as ‘anchor institutions’ in our local areas – using our significant spending power and resources as large employers, purchasers and capital asset holders to help address the adverse social, economic and environmental factors that widen inequalities and contribute to poor health.
With growing staff recruitment challenges, this would be more than a win for the health of our population. We’re already a major provider of education and training and we run an award-winning suite of leadership and personal development courses. More recently, we have begun to establish a successful apprenticeship programme. We need to think how we better ‘connect the dots’ between health, healthcare, education and research in order to build stronger connections with our local communities. These relationships and the scale of our services - we care for more than a million people a year – allow us to achieve a unique position of trust within our communities. We need to be more ambitious about what that can help us achieve with – and for – them.
Acknowledgement of the need to invest and plan for an empowered workforce
The development of the NHS workforce is more important now than ever: we’re seeing rising vacancy rates as well as changing needs and expectations, among both patients and staff. The plan goes some way to acknowledging these challenges. There are commitments to a major expansion in training places, new professional roles, more flexible working and a greater emphasis on career-long learning and development. An ‘NHS workforce implementation plan’ is now in development, led by the chair of NHS Improvement and the chief executive of Leeds Teaching Hospital. All of this should encourage us to build on the work we have started – to establish a genuinely shared organisational vision and set of values, as well as common expectations of the behaviours we should show to one another and to our patients – to put our own workforce development aspirations at the heart of our organisational strategy.
A bigger role for research and innovation in driving improvement
A small but key section of the plan provides clear support for increasing the amount of research undertaken in the NHS and accelerating the uptake of effective innovations, with a strong link to ambitions for digital and the use of data. There are specific commitments to growing the number of people registering to participate in health research; investing in genomic medicine; and introducing new ways of identifying and spreading innovation with additional responsibilities for academic health science networks.
Research and innovation are core elements of our organisation – who we are and what we stand for – crystallised in our relationship with Imperial College London through the Imperial biomedical research centre and with the College and other partners through our academic health science centre and network and a range of other influential collaborations. We are already working to increase the amount of research we undertake through public, charitable and commercial funding and to encourage and support more staff, from all professions, to get involved in research. The plan offers a stronger framework to facilitate these goals.
We’re looking now in detail at the implications of the NHS Long Term Plan. The plan’s ambition and ideas need to be part of the discussions we’re having at all levels within the organisation about our strategy and priorities and will help us renew our engagement with patients, local communities and wider stakeholders. We already have a vision for what we want to achieve – developed through co-design with our staff and partners and encapsulated in our promise of ‘better health, for life’. The plan’s aspirations are so clearly in line with our own vision that it’s vital we make the most of the opportunities it now presents.