The concept of a '7-day NHS' has been a prominent political issue since it was popularised by David Cameron in the run-up to the 2015 General Election. Sadly, the debate has often generated more heat than light, with many commentators preferring to promote sensationalist statistics - about 'weekend effects' and workforce crises - than examine the complexity of the proposal itself. There are different challenges associated with the concept of a '7-day NHS' between primary, secondary and community services. Extending primary care services will be a costly and complex endeavour, which makes it all the more important that the objectives and delivery strategy for this approach is based on genuine public understanding of the issues, as well as informed debate.
Aspects of the '7-day NHS' concept, as it applies to primary care, that have not been fully recognised include:
- The concept of a '7-day NHS' has been shown to be diverse and complex, both at scale and over time. The new government will need to address exactly how it aims to deliver 7-day access to primary care provision and if/how the services offered will ensure quality, equity and continuity of care.
- There is a backdrop of wider primary care and NHS reorganisation in Greater Manchester, and across England, that will affect the implementation of a 7-day access provision for primary care. With Manchester's health and social care devolution providing an early template for Sustainability and Transformation Partnerships (STPs), that are in development in other areas, the incoming government should address how it intends to navigate and negotiate the implementation of 7-day services in areas subject to devolved health agreements.
- The provision of 7-day primary care services to date highlights the challenge of social renewal and the retention of existing staff within the NHS. In addition to current consultations on the expansion of medical education and training of new staff, the new government should urgently consider a renewed effort to identify and resolve the key issues that determine staff recruitment and retention in the NHS.
-Doctor Natalie Ross
Sustainability and Transformation Partnerships
Since April 2017 all NHS organisations now form part of a local Sustainability and Transformation Partnerships (STPs) in England. These 44 Partnerships are intended to enable collaboration across geographical areas to support delivery of health and social care. STPs are to have a basic ‘governance and implementation support chassis’ (STP Board, Chair, programme management support etc.) but many of the fundamental challenges for STPs remain and the incoming Government should consider that:
- STPs are not statutory bodies so may have limited powers to make change happen;
- The current legislation underpinning the delivery of health and social care is not necessarily helpful for establishing and operating STPs. For example, all organisations within an STP are currently regulated separately, and collaboration may be impeded by the operation of competition law;
- More meaningful engagement will be required with Local authorities, the third sector, the workforce (health and care), patients and the public to widen the understanding of what STPs are aiming to achieve and gain buy-in to proposals for change;
- Squeezed budgets in social care and public health are likely to have knock-on effects for STPs and their plans;
- Timescales are very tight, and the landscape is changing fast as accountable care systems are already being encouraged as the next step of STP evolution. Understanding what has worked in which contexts may be difficult in this rapidly changing environment.
- Doctor Anna Coleman
Read Anna's blog for more information on Sustainability and Transformation Plans which have been renamed Sustainability and Transformation Partnerships following the publication of ‘Next steps on the NHS Five Year Forward View’ (2017).
Innovation in Health
Strong economic growth from a Government-led industrial strategy is arguably the most critical factor for national prosperity during the next 5 years as we exit the European Union. The health and life sciences sector has been marked as one of the best opportunities for growth and is an area where UK research is internationally competitive.
- The incoming Government should work to identify those targeted interventions capable of unlocking the fastest and most significant economic growth in the health and life sciences sector.
- The new Government needs to work out what is needed to maximise the free-flow of ideas and people between industry, healthcare and university settings.
- Historically, the UK’s health and life sciences sector has tended to prioritise the quickest possible routes to profit, rather than allowing intellectual property and commercial development projects to reach their full potential. The incoming Government will need to outline an approach that encourages longer term growth of small and medium-sized enterprises, and resists the tendency towards premature exploitation of promising research and practice.
- If there is to be a Government-led industrial strategy for health and life sciences, should this be retained at a UK level, devolved down to regional level across the whole UK or focused on existing areas of strength, such as the ‘Golden Triangle’ of the South East? Government must take a strategic lead on this question and provide clarity and consistency on how the process develops from here.
- Adopting innovation within the NHS to improve care and reduce inefficiency has been challenging. How we identify and overcome these challenges will be a key test for the new Government’s approach.
- Greater integration of health and social care and moves towards personalised medicine generate enormous, rapidly increasing IT and data handling needs. It is vital that Government encourages strategies for unified data platforms that can work across the NHS.
- The OECD PISA school rankings place the UK 15th internationally for science and 27th for maths. The incoming Government will need to create and pursue a new long-term strategy to improve maths and scientific literacy as a contributor to the economic potential of the health and life sciences sector if we are to improve in this area.
-Professor Neil Hanley
The NHS faces many workforce challenges, including:
- Rising workloads and resource pressures
- Long term pay restraint and declining staff morale
- Uncertainties surrounding Brexit and status of existing staff from European Union
- Recruitment and retention of some roles, e.g. GPs, nurses etc.
- Long term deficits in workforce planning, as highlighted by the recent House of Lords Select Committee report on NHS long term sustainability
- A changing context with the rapid development and roll out of new models of care
Policy relating to the NHS therefore needs to take account of:
- Short, medium and long term measures to improve the desirability of NHS careers
- Realistic and evidence-informed understanding of what may be delivered by changes to skill mix, and what such changes cannot deliver. For example, whilst the delivery of care by a range of non-medical clinicians is well accepted by patients, there is as yet little evidence that such care models reduce costs overall.
- The need for greater integration between all health sectors and social care requires multidisciplinary approaches to training and workforce development
- Renewed focus upon long term workforce planning
-Professor Katherine Checkland and Professor Damian Hodgson