In light of the goals set out in the NHS Long Term Plan, David Highton, strategic health advisor at Servita, offers his thoughts on what might be the biggest transformation within the service.
On the 7th January, NHS England chief executive Simon Stevens launched the Long Term Plan to much fanfare. It’s unlikely the launch passed anyone by – the press coverage blanketed the start of the longest month of the year a bit like the snow. The key messages show continuity from the Five Year Forward Plan – integrated care remains the panacea to many of the challenges the NHS faces.
While the focus remains on our exit from Europe, we are unlikely to see a new health bill that will support movement towards integrated care. So, how will the industry achieve this cornerstone of the Long Term Plan without formal governance in place to make it work? Of course, integrated care requires collaboration across the healthcare ecosystem, for partners to act as one. For anyone who has worked with, or even been a patient within the health system, this seems a tall order. But there a number of ways to achieve it; set up a partnership board with each provider having a seat at the board – a shared sovereignty model if you will, in other areas we are likely to see one provider take a lead position or a third option of a partnership approach whereby innovative contracting is used with shared financial risk.
What can we do to help enable the digital transformation necessary to tie providers and systems together in an intelligent way? In essence the transformation is trying to get all parties in a local area to act as one organisation. That’s where the IT enabling comes in. You either move everyone onto same system (unlikely in most areas) or have different organisations collaborate to make systems work together better.
There is still a big push on hospitals to be totally digital and paperless by 2024, previously 2020. The plan also talks about shared records across the local NHS. But how do you transform services and take individual patient pathways from primary care to community care into the hospital and back out again when there isn’t a single IT platform to do that? That’s where shared care records come in, linking different systems together in a way clinicians can use.
The plan talks the digital transformation talk but beyond that we need different organisations to work together. We need to re-design outpatient services so that patients have the right to access digital primary care services with their doctor – think Skype for outpatients instead of a visit to the local GP, allowing for digitally enabled outpatient services. Although there is a lot of scepticism in the service over this approach.
The greatest transformation we shall see will be joined up care. We are not assuming that hospitals will get smaller – it’s not type of transformation – in fact we are likely to see a 10-15% growth in healthcare need over the next few years. Much of that growth will be directed at primary and community care, so efficiencies and the biggest transformation will need to be found from secondary care, mental health and community services – utilising technology to redesign services and reduce outpatient visits.
While political eyes are elsewhere it will be interesting to see how much of the weighty plan will be realised, but be in no doubt that change and transformation must happen if we are to continue providing the quality services we expect from our NHS.