The newly-unveiled NHS long-term plan reveals an extraordinary breadth of ambition for improving healthcare over the coming decade. While it includes exciting developments in cutting-edge technology, such as gene therapy and artificial intelligence, the greatest improvements in care and outcomes will come not from scientific breakthroughs but from people: by harnessing the power and talents of patients and NHS staff.
To stand a chance of the plan succeeding, the health service needs to ensure clinicians have the power and responsibility to make change happen and do far more to exploit the largely untapped resource of patients themselves.
One of the plan’s key goals is to reduce unjustified variations in performance, including significant differences in stillbirth and newborn baby death rates. This can succeed only if frontline staff are gien the skills, resources and encouragement to improve quality. Clinicians have to believe they are leading this locally, rather than simply being a cog in a national blueprint. That needs to be central to the workforce strategy, the plan for tackling thousands of NHS vacancies, when it is finally published.
The remarkable improvement the Care Quality Commission has just highlighted at Brighton and Sussex University hospitals NHS trust – which has gone from an inadequate to good rating by supporting and empowering staff – shows how change happens. It has come about not through buying some new kit but by putting patients at the centre of everything the trust does, and by equipping frontline staff with the skills and processes to build a culture of continuous improvement.
The plan could also show a lot more ambition in liberating the power of patients, the one resource the NHS has in abundance. Similar to empowering staff, giving patients a greater role in managing and taking decisions about their care needs to be threaded through the entire programme, not seen as an additional project.
The landmark decision within the plan to develop integrated care systems across the country by 2021 means there will be growing pressure for NHS organisations to work for the benefit of the whole local health service, rather than just themselves. But this is hard, and will take years to implement. Greater Manchester has probably done more than any area to make partnership working for the good of the whole system a reality but even there, as a recent study highlights, it is more talked about than acted upon. Again, equipping staff with the skills and support to work in this new way will be crucial.
The plan states that investment in primary and community services will grow at a faster rate than the overall NHS budget for the next five years, with £4.5bn a year being invested. This is bold, but there’s a risk that the NHS will then simply revert to business as usual, with hospitals continuing to dominate resource allocations.
Switching to more preventative care takes time. Israel, one of the few healthcare systems in the world that can truly claim to be primary care led, has spent more than 30 years relentlessly bearing down on hospital costs while investing in community clinics and preventative care. Since around the turn of the century, its community services have attracted substantially more funding than hospitals. Citizens have to join one of four health maintenance organisations, which deliver impressive outcomes at lower cost than the UK.
If the NHS is serious about becoming a service that intervenes early and supports people to look after themselves, it needs to hardwire a fundamental shift in resources to community services to be sustained over many years, not just five.
The big lesson from the strategy the new plan is superseding – the Five Year Forward View – is that implementing change in the NHS is hard and takes a long time. Institutional inertia, disempowered staff and too few people having the skills to make improvement happen are just some of the reasons. As the health service works out how to implement the long-term plan, there must be a relentless focus on creating the right conditions for system-wide change. Unleashing myriad projects won’t work unless the ground is prepared first.
• Richard Vize is a public policy commentator and analyst