While it must be a positive step for prevention to be in vogue, these are ideas likely to be confounded by the brutal cuts that have been before – and an unwillingness to look to effective population-wide measures, such as a minimum unit price for alcohol; reducing sugar levels in food; and greater restrictions on junk-food marketing.
For Dr Bhatti, talk of prevention is cheap, and action would speak much more loudly. ‘There’s no point fiddling while Rome burns,’ he says.
One of the plan’s biggest focuses is on reforming services – particularly boosting primary and community care, personalising care, increasing digitalisation and, perhaps most prominently, local integration.
More care will be expected to be provided at urgent treatment centres, rather than emergency departments, with more being unveiled across the country. Multidisciplinary teams are to be set up in primary care networks which GP practices will be asked to join, and 200,000 more people are to be given a personal health budget by 2023/24. It also suggests every patient will have a right to access telephone and online consultations within the next five years.
Integrated arrangements, where different parts of a local health system are asked to come together to plan care for patients jointly in their area, are now expected to cover the whole country by April 2021 with integrated care systems, which are voluntary partnerships, and integrated care providers, contracted bodies responsible for an area’s services, supported by NHS England.
(SOURCE: The Health Foundation)
The BMA has consistently welcomed greater integration and reduced duplication of services, while insisting the proper investment must be available to achieve it.
Dr Bhatti says: ‘I would welcome greater integration but it shouldn’t be about saving money – it should be about better outcomes and better flow.’
But there is one main stumbling block in the path of this integrated future for the NHS: legislation. The 2012 Health and Social Care Act enshrines competition and procurement regulations – facilitating a bloated internal market and tendering bureaucracy. Until parts of this system are gone, integrated care will go nowhere fast. And NHS England has dropped welcome hints that change could be on the way in the plan – suggesting legislative changes would enable ‘more rapid progress’.
The plan suggests impediments to ‘place-based’ commissioning – another term for integrated-care arrangements where services are planned and provided by a body or group of organisations for their local area – could be removed. And it also suggests allowing the creation of ‘integrated care trusts’, the removal of general competition rules and cuts to procurement processes.
Dr Nagpaul says: ‘At a time when the NHS can least afford it, too much time and money is spent on tendering processes for contracts. Given the long waits for treatment and the cash-strapped state of our health service, time and money should be spent on the front line, delivering better care to patients, not on costly tenders.
‘These competition rules have also resulted in a fragmented NHS driven by commercial motives rather than providing patients with seamless care.
‘When Government rhetoric is centred around integration within the health service, independent providers bidding on time-limited contracts sits entirely at odds with this philosophy. Only by removing the requirement to put services out to tender, can local systems work together to ensure cohesive patient-centred healthcare.’
‘The sustainability of the NHS requires a robust workforce plan that addresses the reality of the staffing crisis’
In mental health, the plan renews the previously asserted commitment to grow investment in mental health services faster than the NHS budget overall for each of the next five years, including expanding access to Improving Access to Psychological Therapies services and ridding the NHS of out-of-area placements. However, the promises are vague, according to BMA consultants committee mental health lead Andrew Molodynski (pictured below).
‘What they are doing is good in a way and it is sustaining some improved investment but it’s actually only really holding the position where we are now. This money is not going to be transformative, it’s just looking to keep us where we are,’ Dr Molodynski says.