The future of health policy

27 March 2015

Health policy can operate in the rarified atmosphere inhabited by academia, think tanks, royal colleges and Whitehall departments. The weight of our combined intellect is admirable and filled with potential. Yet, policy only matters when it directly connects to the purpose for which the NHS was created. It needs to operate in a sphere, to crib from the NHS Constitution, at the limits of science and at times of basic human need where care and compassion are what matter most. This is particularly true today.

We are living through unprecedented times of consensus. Consensus on the scale of challenge faced by the NHS and consensus on how care needs to shift if we are to have a sustainable NHS. To back this, we have 23 national organisations representing patients, citizens, local government, public health, managers, doctors, nurses, therapists and support staff – everyone – signed up to the NHS Confederation’s 2015 Challenge Declaration, Manifesto and Prescription for the election. A consolidated “front line” view of how the world needs to change.

This sits alongside the Five Year Forward View as a bold vision for health policy by the six main national bodies. The national view and the local view differ little, putting politicians in a place where their role has never been clearer: to deliver on the financial context and the political will to back extraordinary change.

This change sounds very benign in many ways. It centres around the following:

  •  A step change in wellbeing and the public’s health;
  • Supported self care provided at scale, with technology and peer support reflecting the rest of our lives and the services we use;
  • Joined up physical, mental and social health and care, for people affected by frailty using GP lists as the cornerstone;
  • Networked small hospitals with financial and clinical viability supporting acute and elective work;
  • Consolidated hyper specialised centres that are world class;
  • A new reality of 7 day services, integration, patient leadership, quality and service improvement driven by staff and transparency.

None of this is new and it feels like these are ideas whose time has finally come and where they will fall on fertile ground.

What is clear is that this needs to happen quickly and we need to learn the lessons of the past. For example, our collective failure to deliver the “fully engaged scenario” from the 2002 Wanless report demonstrates how policy has not always been clearly linked to purpose. Delivery has been hobbled because the levers have been poor and priorities have been often a matter of rhetoric not reality. Four example, our obsession with process targets around waiting time reflects their importance and undermines every attempt to consider care outside hospital, prevention and inequalities.

I would like to propose that we get to a point where all policies are kitemarked as Mickey Mouse policies. This is currently a pejorative term but we could do with taking a lesson from Walt Disney. Walt was successful on the back of a simple approach. He believed he needed to have three types of people around him:

  • A dreamer – creating a bold vision of a possible future;
  • A realist – looking at how to deliver the dream in practical purposes;
  •  A critic – who pulled apart the realists plan.

The balance of the three created reality of dreams.

The questions we should always ask is: have we left policy to the dreamers?  We need a balance of all three, and quickly, whilst recognising our realist may be hobbled by a complex system of levers and the critic too powerful. In an era where frailty and comorbidity are the biggest drivers of cost, the lack of research evidence into both is a problem. Similarly, the evidence on dealing with childhood obesity, and capturing social value, are emerging fields.

We need to turn policy into practice to support purpose. We need to take prevention, supported care, integration and make them work. We have no choice. That is part of the future of health policy. It should deal with much of the NHS Constitution, especially the “times of basic human need” issues.

The work at the “limits of science” is something that needs to be kept in view. If we believe there is “nothing new under the sun” then the worlds of big data and genomics are about to shatter.

As we struggle to deliver on ideas whose time has come, the world is about to change forever. When it is claimed biomarkers on a genetic mutation within a single cell can be used to test in real time whether a cancer treatment is effective, we know the world has changed. Yet we are at the very beginning of the choices we can make and the use of these new fields in health and care. They could be forces for good allowing us to drive down costs and increase social value and efficiency or they could became detached from the aims and goals of the NHS and of citizens.

So I am calling us to learn from Walt here too. When thinking about the future of health and care – something that is deeply connected to our very being – the dreamer, the realist and the critic are needed now more than ever.

Rob Webster, Chief Executive, NHS Confederation

The NHS Confederation has recently published a 2015 Challenge Declaration, a 2015 Challenge Manifesto and a 2015 Challenge Prescription.



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