Published by Rt Hon Jeremy Hunt MP, Secretary of State for Health on 9 March 2017
- Our Work
- The Reformer Blog
In March 2017, Reform held a major health conference exploring NHS reform at pace and scale. During the conference we explored Sustainability and Transformation Plans, workplace health and better care for less.
Current ambitions for NHS reform rest on the success of Sustainability and Transformation Plans (STPs). The 44 STPs covering the whole of England are the main delivery vehicle for the Five Year Forward View, which aims to strengthen prevention and primary care, develop new care models that reduce the burden on acute hospitals and deliver much better value for money. These changes are also needed to deliver the financial targets agreed by NHS England i.e. to achieve £22 billion in efficiency savings by 2020-21, thereby needing no additional financial support from the taxpayer.
The idea of STPs is that local health economies, rather than individual NHS organisations, are best placed to decide together how to reform health and social care in their areas. STPs will encompass all health bodies – primary, secondary, tertiary, mental health providers and commissioners – and also local authorities, who are responsible for social care and public health provision.
STPs should enable these different organisations to look beyond a ‘fortress mentality’, in which each acts in its own self-interest rather than in the wider population interest.
Many of the best examples of integrated practice come from areas with a long history of working together. Manchester for instance has all but joined up health and social care spending and some regions have detailed memorandums of understanding to enable streamlined integrated working.
STPs are the right idea but as the recent Reform report, Saving STPs, outlined, they are unlikely to succeed within current constraints. Progress has been stifled by a lack of buy-in from local authorities, clinicians, the public and politicians. The fragmented payment systems across the NHS and social care prevent organisations working together and STPs lack the executive authority needed to drive change.
The paper recommends that to save STPs, and their reform programme, Ministers should give them full control of the total NHS and social care budget in their area. A single body in each STP area should commission all health and social care. In due course STP leaders should be locally elected in order to secure local buy-in for its proposals for change.
Permanently reducing the stubbornly high incapacity-related benefit caseload – currently around 2.5 million people – means addressing the flow of people falling out of work due to ill-health or disability. With less than 1 per cent of claimants leaving Employment and Support (ESA) Allowance in any given month, the need for early intervention to prevent others from facing years trapped on benefits is clear. And since more than half of ESA claimants flow on to the benefit from employment, the workplace is the obvious place to start.
The business case for employers is also strong: improving health in the workplace would reduce the cost of sickness absence and recruitment, and increase engagement and productivity. Whilst there is evidence to suggest employers are concerned about the cost of workplace adjustments, the average cost is estimated to be just £75 per person. Employer-led occupational health provision and workplace adjustments are a sound investment.
Whilst the benefits of improving health in the workplace are clear, the Government’s role in enabling this is more complex. Reform to Access to Work – by increasing awareness, efficiency and the ease with which employees can move their grant and equipment between employers – would be a quick win. Requiring more of businesses that are part of the Disability Confident campaign and setting an example by improving workplace adjustments in the public sector are other good places to start. Effectively disseminating good practice and overcoming more systemic issues of stigma and discrimination must ultimately, however, be driven from within businesses themselves.
Innovation is never easy; it’s hardest when people’s lives are at stake. But it is now the only option for the NHS. A population that is living longer, but not necessarily healthier, lives will push public spending to unsustainable levels. Jeremy Hunt has rightly called for a “revolution” in the way healthcare is delivered.
Revolution entails a break from the 1948 model of care. People with chronic conditions should receive care in the community or at home, not hospitals. Large primary-care providers – with patient lists of over 10 times the size of the current average – can deliver outpatient appointments and encourage self-management of conditions such as diabetes. Even those with emergency needs should stay out of A&E: urgent-care centres in new GP practices can save over £1 billion a year if applied nationwide. This is much more convenient and will allow ministers to focus on health outcomes, not waiting times.
New technology can facilitate this new model. Triaging apps on smartphones can provide advice for over 60 million GP appointments used by the ‘worried well’. Video calls with clinicians are more convenient for patients, and 40 per cent quicker than face-to-face meetings, excluding waiting times. This can free time for clinicians to devote to those who would otherwise go to A&E – saving £600 million a year.
Accompanying this should be a new way to use the workforce. Using apps and online booking could replace the need for up to 24,000 GP receptionists, whilst 90,000 administrator roles could be automated in secondary care. Clinical staff can be used in more effective ways. Pharmacists and nurses are best placed to provide care for the 56 million GP appointments conducted for minor ailments. This simple switch would save over £700 million a year alone.
This represents not just a quickening of current processes, but a new culture of care: one that focuses on delivering better care for less. This is the innovation the NHS needs. Vive Hunt’s revolution.