The Clinical Services Journal looks at the challenges and priorities which must be addressed to achieve more integrated, effective and sustainable care, as outlined by the NHS Confederation.
At the 2016 NHS Confederation Conference, Simon Stevens, chief executive of NHS England, acknowledged how demanding the past 12 months have been for frontline staff. Despite the media focus on the negatives, he said he believed that the quality of care in the NHS today, for the vast majority of conditions, is better now than it has ever been. “This is not just due to the quality of clinical care,” he said. “It is also down to the compassion and sensitivity with which care is offered.”
Since he took on his present role, Simon Stevens has been trying to establish a shared consensus about how health needs to evolve. He said: “We are creating more alignment nationally, between the various parts of the system and the creation of NHS Improvement, which I believe is an important building block and makes the argument for a stronger funding settlement for the NHS.”
Focusing on the tasks facing the NHS in the coming years, Simon Stevens explained the need to stabilise finance and operational performance. “We have had to strip out 1% – around £650 million – of spending from funding that would have been available from CCGs for mental health services, community health services, primary care and other things. We want to be able to release that funding.”
Rolling up our sleeves
Simon Stevens also emphasised the need to “get our sleeves rolled up,” to deliver on some of the key national priorities and strategies that have been have laid out and, to help achieve this, five operational managers have been appointed in the NHS. Pauline Phillips is leading implementation on urgent and emergency care review, Cally Palmer, chief executive at Royal Marsden, on cancer, Clare Murdoch on mental health; Sarah Jane Marsh on maternity services, and Sam Jones on vanguard sites. These five front line leaders have been tasked with connecting the national implementation agenda with the local work, which has got to be delivered in every part of the country.
So what does ‘getting our sleeves rolled up’ mean in reality? Using cancer services as an example, Simon Stevens said: “We need to find out the reasons behind endoscopy bottlenecks to speed up waiting times. Cally Palmer will be looking at this issue and will be talking to the re-formed cancer alliances about this and other issues.
“Clare Murdoch will be doing the same on mental health. The practical things that need to be achieved include work to reduce out of area treatments and to connect secondary and tertiary mental health services.
“Alongside this we need ‘open book’ transparency from CCGs, so that their mental health Trusts can see where mental health investment is – or is not – going. Then we can have an honest conversation,” he said.
Integrating health and care
Stephen Dalton, chief executive of the NHS Confederation, has introduced ‘Stepping up to the place’, a joint publication about integrating health and care services. Produced by the Association of Directors of Adult Social Services, the Local Government Association, NHS Clinical Commissioners and the NHS Confederation, the evidencebased document describes what a fully integrated, transformed system should look like, with the aim of bringing health and social care together. The imperative to integrate and transform has never been greater, said the report authors – from finding ways to organise services around the demands of a population with more complex and chronic health and social needs, to responding to the challenging financial context for the NHS and local government.
The document is supported by a selfassessment toolkit designed to support local health and care leaders through health and wellbeing boards to critically assess their ambitions, capabilities and capacities to integrate services to improve the health and wellbeing of local citizens and communities.
Integration is an important step towards transforming services for adult social care to ensure they are sustainable for the future and that they offer truly person-centred care. The report states that redesigning services around the needs of an individual provides the best opportunity to improve that person’s health and wellbeing including closing health inequalities and helping to bring financial sustainability. This consensus was developed from evidence emerging from where integrated approaches have been implemented – including trailblazers such as integrated care pioneers and vanguard sites, as well as national programmes including the Better Care Fund. Evidence indicates that integration results in improved clinical outcomes and a better patient experience. There is also evidence that person-centred services can change the pattern of demand and can offer service efficiencies.
The report highlights the need for system transformation to achieve greater integration and calls on national leaders to address a number of fundamental questions. Although different places will develop an integrated system tailored to meet local needs and aspirations, there are common issues that need to be addressed and these are also explored within the document.
The NHS Confederation recently outlined four key proposals for how the Government can support the NHS to achieve sustainability in a time of immense financial challenge. The NHS Confederation stated that it is hearing repeated concerns about the future sustainability of the NHS from within the service, commenting that to deliver the Five Year Forward View (5YFV), its members needed to be afforded the “right conditions to transform the service to one which is sustainable for the future.”
According to the NHS Confederation, these conditions are not being met in full and this “threatens making a tough challenge impossible”. Most notable, it says, are the “decisions to cut spending on public health through the local authority grant” and delays to “much needed social care funding.”
It warned that, while these cuts may deliver a short-term saving for the Treasury, there are strong indications this will come “at the expense of significant long-term costs and the possibility of hindering transformation.”
In addition, the NHS Confederation has outlined four proposals to address concerns on delivering transformation and sustainability in the NHS.
Phil McCarvill, deputy director of policy at the NHS Confederation, has previously highlighted funding as a serious concern, following the publication of the report ‘Social care for older people: Home truths’ by The King’s Fund and the Nuffield Trust. He described insufficient social care funding as “the most urgent threat to the NHS and the wider health and care system.” The NHS Confederation has consistently called for an end to seeing the NHS, social care and public health as “three separate funding streams” instead viewing them as part of a single system.
“If we are to truly join up health and care then we need to support people to receive the care when and where they need it. Inadequate funding in one part of the system has a profound impact on the other parts to deliver the right care. Without this, local coordination and planning will become increasingly disjointed and the care individuals receive will suffer,” Phil McCarvill commented.
In its latest statement to the Treasury, the NHS Confederation re-iterated that, if social care and public health funding are not fully protected, this will have a significant impact on the ability to deliver the Five Year Forward View.
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