The government needs to explain to the public how care is going to change

Recovery and reform. These are the two immediate and significant tasks facing health and care leaders. The government’s recently announced plans to reduce acute waiting lists will be a crucial step towards system recovery.

As for reform, it has laid down the three shifts it wants the health and care system to deliver. The government’s now much-anticipated and forthcoming ten-year health plan, to be published this spring, should set out a roadmap for doing so.

The Darzi Review, published last autumn, found that the NHS has failed over the last 15 years to deliver its strategic priority of integrated, preventive care closer to home. To succeed where past efforts failed, the new ten-year health plan must do three things:

• Devolve power to ICss to lead reform while government acts more coherently. A more devolved and integrated structure in which the NHS, local government, and social care can work together and better engage the public is more likely to drive and deliver sustained reform. Given 80 per cent of health outcomes are due to wider determinants than just healthcare, the plan should set out a cross-sector approach to improving population health and tackle inequalities. The government must align policy changes in the ten-year health plan with wider reforms to social care and local government.
• Provide a consistent set of policies to sit behind the three shifts. Too often, the goal of preventing worsening ill health tomorrow hasn’t been matched by concerted action due to the immediate pressures of today. To break the mould, the plan should commit to developing metrics to measure success, system oversight that enables work both for today and tomorrow, and hardwiring financial flows through new payment mechanisms within systems that support a move towards prevention and care closer to home.
• Be honest with the public about how the reforms will impact their experience of care and meaningfully involve them in designing services. Despite extensive engagement, public expectations may be at odds with what delivering the government’s plans will mean in reality. The government needs to explain that some acute services may need to close in order to deliver more appropriate care closer to people’s homes. Key to this will be giving communities a greater role in designing care and its delivery.

For ICSs to lead reform, accountability must be flipped on its head, allowing patients and communities to manage and improve their own health. Given the pressures of top-down performance management, attention is often on the immediate priorities such as waiting lists and general practice access, rather than engaging with the public.

Healthcare leaders want to co-design services with local people so that patients sit at the centre of the new model of care, but need to be allowed the time and space to do so.

To allow for change to happen, national bodies must give healthcare leaders support for leadership development and improvement that focuses on cross-sector collaboration and driving system-wide change. Peer review, an effective driver of improvement in local government, should be expanded in the healthcare sector to support systems to become self-managing and self-improving. The public won’t always see these behind-the-scenes changes – but they will benefit from high-quality, joined-up care, delivered in a setting of their preference as a result.

Digital technologies have the potential to empower people to access their personal data and self-manage. But the government’s digital ambitions are currently out of step with the system’s capabilities and the public’s expectations

A consistent set of policies is also needed to enable the system to progress the government’s stated short- and longer-term priorities. Instead of focusing on just volumes of activity, the government needs to be crystal clear about the outcomes it wishes to achieve through a new model of care, and then how it will measure and reward them. This will allow local leaders to better use scarce resources, with different teams working together towards shared goals, not just transactional activity and onerous reporting.

Local organisations and systems that have successfully reoriented their work around outcomes have: relieved pressure on acute settings; delivered personalised, integrated, preventive care, especially for people with multimorbidities; and harnessed technology and data. But delivering the shifts requires focused, long-term, and measurable national goals that matter to citizens.

Finally, as the government tries to fundamentally change our model of care, it must be prepared to explain clearly to the public about how people’s care may change. Our current care model treats body parts rather than the whole person. This is fine for people who are generally healthy and can access care on an episodic basis when issues arise. But those with multiple long-term conditions — who often face significant social needs and who account for 70 per cent of demand for NHS care — need a more holistic, personalised model so they don’t fall between the cracks of separate pathways, services, and providers. Digital technologies have the potential to empower people to access their personal data and self-manage. But the government’s digital ambitions are currently out of step with the system’s capabilities and the public’s expectations.

With his three shifts, the health secretary has injected much-needed clarity into the health and care system. But the ten-year health plan is just one piece of the public sector reform puzzle; maintaining focus will be no easy task in the context of ongoing service pressures and the reform of local government and social care. Bravery is needed to balance public expectations with the reality of delivery.

Annie Bliss is a senior policy adviser at the NHS Confederation. You can connect with Annie on LinkedIn.