In June, the prime minister announced a new NHS funding settlement, with an additional real terms £20bn over five years, and asked the service to produce a sustainable long-term plan, “with leaders of the NHS, with clinicians and health experts” working together.
This autumn, NHS Providers held roundtable discussions at Liberal Democrat, Labour and Conservative party conferences, bringing politicians together with a diverse range of stakeholder organisations. At each, we asked attendees what the priorities should be for the NHS long-term plan, with a focus on child and adolescent mental health services (CAMHS) at the Liberal Democrats, performance targets at Labour, and priorities for the plan at the Conservative conference.
Kerry Racher, external affairs advisor, shares ten quick reflections from the conference season.
- At each roundtable there was consensus about the scale of the challenge facing the NHS, with tensions between conflicting demands: we need to show the value the service brings and what it can achieve with more funding, but at the same time day-to-day performance is under severe pressure that has to be relieved. Our attendees welcomed the opportunity brought by the long-term plan to set out a realistic path to sustaining and improving patient care and ensuring the NHS continues for another seventy years.
- There was agreement on the magnitude of the challenge facing mental health services, including the need to ensure funding reaches the frontline and to improve access to treatment. We heard possible solutions including shifting the balance towards children and young people – looking at the impact of trauma in early years and focussing on prevention – and providing support in the community to prevent escalation and hospitalisation. We also heard that to achieve true parity of esteem, mental health should be incorporated into wider government strategies, including workforce, rather than having a stand alone mental health strategy.
- The long term plan must encourage a move towards prevention - around 40% of premature deaths in the UK are caused by preventable cardiovascular disease, diabetes and cancer. It is essential that focus shifts to addressing life styles and encouraging people to take control over their health. Trusts are already working in this space, for example the Let’s get moving project in Morecambe Bay that encourages children to ‘run a mile’ every day, resulting in a dramatic improvement in the children’s physical and mental health, and educational performance. Reflecting on targets, our roundtable attendees looked at the value of using targets to draw attention and resource to prevention work, for example, to drive reductions in child obesity, give the best start in life, as well as improving cancer screening uptake and immunisation rates.
- A recurrent theme from all three conferences was workforce: trusts have told us for some time that workforce is their biggest concern and this was echoed by stakeholders around the table. Nationally, the vacancy rate is nearly 12% for nurses and over 9% for doctors. The serious shortage of staff, especially nurses, has huge implications for an NHS struggling to cope with increasing demand pressures. Attendees also raised the need to better engage clinicians and improving wellbeing for staff.
- Improving technology – one of the secretary of state’s priorities – should be a key part of the NHS plan, but rather than high-profile apps, we heard that a central IT system should be a priority. This will ensure that patients are able to move through the system and know that at each appointment they have, the person they see will have access to all their medical notes, and they won’t have to tell their story each and every time. We know that the NHS is already developing these new ways of working, for example the Salford Together vanguard developed a shared integrated record when social care staff transferred across, and any ideas or learning we can share from this is invaluable given their knowledge of what patients want and expect.
- Whilst there was consensus that it is important to have a set of targets that express the quality of care that should be provided, we heard that targets should be system-wide. Attendees were looking for targets that tell us something broader than what is happening in one place, something that shows what is happening across the system. Attendees also reflected whether it was more helpful to talk about standards – and so create a minimum care quality to expect – rather than targets.
- Social care and the NHS are two sides of the same coin. This has been recognised in the extra £240 million for social care this winter, announced by the secretary of state for health and social care, intended to be used to ensure patients can be discharged promptly. But we heard that it’s not just about funding, it’s about how we value staff. We pay those working in social care less those doing similar roles in the NHS. This disparity should be addressed in the government's forthcoming green paper to ensure that the sector can attract enough staff to deliver the increasing levels of care needed.
- Underpinning our discussions was the need for closer integration for health and social care, to ensure patients get the right care in the right place at the right time. There are opportunities across the sectors to relieve pressures, for example, earlier care in the community could help prevent someone’s needs escalation, while greater availability of social care provision would further reduce delayed transfers of care.
- The long-term plan will need to reconcile multiple competing priorities for the NHS, but it is critical to be realistic about what can be delivered with the funding available. We must also look at what sits outside the funding uplift, and ensure enough attention – and investment – is given to addressing infrastructure and maintenance backlogs, workforce training and education, and public health.
- Finally, in the current political climate where Brexit is dominating, it was great to talk about the issues facing the NHS and come up with positive ways of feeding into the long-term plan and finding ways to rebuild the NHS around the needs of patients today. As representatives from NHS trusts and other health stakeholders gather in Manchester next week for NHS Provider’s annual conference and exhibition, we look forward to continuing the discussion.