The problem of DTOC has basically been addressed, but the problem of demand most certainly has not
This blogpost was co-authored by Richard Hills.
In the week since the NHS’s 10-year long term plan was launched, my colleagues and I have taken the time to read it thoroughly and reflect on what it contains.
The King’s Fund stated in their response to the plan that ‘while today’s plan is a significant step forward, a number of questions remain unanswered. There should be no illusions about the scale of the challenge ahead’.
While that is true, the plan nonetheless deserves to be championed for recognising several critical issues, including the need for: investment in community and primary care (it ring-fences funding for this), acute hospitals to be given a fighting chance of achieving financial sustainability whilst care models change; a focus on managing demand; investment in mental health services; a focus on prevention and personalisation; promotion of digitalisation; and tackling workforce shortages across a number of professions. Importantly, the plan also recognises that it will take time to deliver all of this sustainably.
There are also a number of pledges and policies that will resonate with local authority partners, including those related to the level of support for carers, social prescribing, homelessness, care homes, intermediate care and volunteering. The plan also moves Integrated Care Systems (ICSs) front and centre, as the delivery mechanism through which NHS England is attempting to translate long-stalled STP talking shops into something real, following the work of the vanguards. This is a significant step forward.
However, perhaps inevitably the plan does not address some of the most fundamental barriers to change. These include:
1. The need for a cross-government plan to tackle health and social issues at the interface
It has never been clearer that to enable people to live their lives independently for as long as possible, the NHS and local government must work together. This requires recognising that the solutions to many of the problems service users are grappling with are distributed across the boundaries of responsibility between the two sectors. Tackling these problems requires reframing those boundaries, and focusing on factors that can be influenced as well as those that can be controlled. However ,the 10-year plan only looks at factors that can be controlled by the NHS.
An example is the plan’s approach to prevention. The NHS can ‘control’ secondary prevention through initiatives such as increased cancer screening, smoking cessation services and type 2 diabetes prevention programmes – but these initiatives are a response to a problem that already exists. Tackling the root causes of cancer, smoking and obesity through primary prevention and lifestyle change requires a joint approach with public health.
2. The need to address obstacles to joint working between the NHS and local authorities
Organisational siloes, procurement laws, funding pressures, workforce shortages, data sharing and differing eligibility criteria all remain obstacles to local authorities and the NHS working together – yet none of them are addressed in the 10-year plan. It remains to be seen to what extent the social care green paper complements the statements and commitments made in the plan, but it is clear that the success of both documents will rely on the barriers being addressed jointly.
3. The need to tackle issues related to culture and behaviours
The NHS are masters at responding to a crisis and the profession often attracts people who thrive in crisis situations. But successful implementation of the 10-year plan requires a different focus – one that moves away from crisis management and invests in a more proactive approach. It is vital that people are empowered to make their own choices, to build on their strengths (and the strengths of their families, communities and networks) and to manage risk differently.
To bring this about requires challenging identity, beliefs, culture and behaviours, as well as changing structure, process and practice. The best approach to bringing this about is through making changes at the frontline, evidencing the impact they are having on people’s lives, gathering momentum through sharing practice, and through adapting and scaling them up.
The NHS 10 Year Plan represents a significant commitment to the health service in uncertain times, and this should be applauded. However, tackling the issues at the interface between health and local government, ensuring fundamental barriers to change are addressed and placing a greater emphasis on culture and behaviours are all vital if this approach is to improve outcomes and deliver value for money for the taxpayer.
At iMPOWER we focus on tackling the fundamental barriers to delivering change at the interface between health and social care. If you would like to talk to us about how we can support you in this process, please contact us.