The general election result, which few anticipated, could have significant implications for the trajectory of the NHS.
As the service approaches its 70th anniversary, healthcare in England has arrived at an important juncture. The introduction of Sustainability and Transformation Plans (STPs) offers the potential to drastically shift care to out of hospital settings, delivering on the promise of the Five Year Forward View. But demographic pressures and a continuing environment of public spending constraint present a challenging backdrop. In this context, the new hung parliament will offer an intriguing platform for debate; whether it lasts the full five years is less certain.
Theresa May has moved quickly to fill the vacancies in the Department of Health, and providing some stability by keeping three other ministers in place. As Jeremy Hunt assembles his team this week, what will be top of the ministerial in-tray for primary care?
- Backing up the manifesto promises
The Conservative manifesto promised the most ambitious programme of investment in buildings and technology the National Health Service has ever seen. The need for this strategic investment is evident– we have not had a proper plan for NHS buildings since the 1960s, and the majority of the primary care estate is ill-equipped to accommodate the objectives of the Five Year Forward View.
But in the busy Westminster calendar immediate events (such as Brexit) often take precedence. It will be the responsibility of all those with an interest in improving outcomes for patients to ensure the Government invests (both politically and financially) in integrated primary care. Initial signs are promising, with Jeremy Hunt telling the NHS Confederation Conference last week that the Conservatives would fulfil “their side of the bargain” to deliver capital investment.
To kick start this process, officials and ministers in Richmond House should move quickly and decisively; progressing with the creation of a new, powerful NHS property board, encouraging the 44 footprints to stress-test local estate plans, and reaching out to private investors capable of doing the financial heavy-lifting within primary care.
- New models of care: decision time
Over the past two years, the 29 vanguard sites have enjoyed a high degree of autonomy. Pursuing a ‘what works’ approach is eminently sensible; the whole point of these new models of care is to encourage experimentation and avoid a one-size-fits-all approach that blighted the NHS before.
However as different models mature, there are signs of consolidation. During his conference speech in Liverpool, Simon Stevens reiterated evidence that shows Primary and Acute Care Systems (PACS) as more effective at mitigating emergency admissions. The selection of the eight areas to become Accountable Care Systems (ACSs) gives further clues, with the balance tipping away from several multi-Speciality Community Providers (MCP) sites in the East of England.
Whilst models have developed at different rates, it will be important to avoid the temptation to prescribe solutions from Whitehall. The new ministerial team, in partnership with NHSE, should wait a little longer to judge how these models embed themselves within the STP process.
- Securing buy-in for the STP process
The government cannot allow itself to view the election results as the death knell for transformation. Ministers must therefore resume work on the STPs. Legislation to aid transformation was in the works for 2019 prior to the election result, with the acceptance that little can be done prior to Brexit. Whilst Simon Stevens has been very effective in navigating around the 2012 Health and Social Care Act, STPs are likely to reach a legislative roadblock. The debate on the flexibility of the current system is fervent; Jim Mackey argued last week that the sector can do 90% of what is needed under the Health and Social Care Act as it is now.
Meanwhile, the Health Secretary has admitted “the legislative landscape has changed” and it may only happen with cross-party support. We would not anticipate major reform before April 2019, but anything much deeper into the parliamentary term could come too late.
- Tackling workforce challenges
Hunt and Stevens are acutely aware of the workforce issues currently facing the NHS. Recent figures have shown a dramatic decline in EU nurses registering to work in the UK and the chief executive of Health Education England last week made it clear the priority must be retaining staff. Within primary care, the GP Forward View target to recruit 5,000 more doctors by 2020 looks less achievable as each day passes, but action has to be taken. The strides made in filling GP training places in Wales in 2017 suggests progress is not impossible.
Ministers can at least be assured of public support for investment in NHS staff. A poll commissioned by The Whitehouse Consultancy found that 55% of over 2,000 people surveyed want the government to prioritise the workforce, ahead of other focus areas such as A&E waiting time targets. The government would do well to respond, by turning Jeremy Hunt’s hints about ending public sector pay restraint into reality. Greater capacity is also clearly needed to fulfil the Conservative manifesto promise to deliver extended GP access across 7 days a week to the entire country by March 2018.
As is often the case during general elections, the state of the NHS has drawn the political spotlight over the past six weeks. A hung parliament brings the risk of a legislative logjam, and therefore attempts to secure a consensus on the overall direction of travel within our health service will be more important than ever.
Robert Ede is a Senior Consultant at The Whitehouse Consultancy