P for personalisation
Here there is good news. Person-centred care is embedded at the heart of the ‘new service model’ that the Plan proposes.
The comprehensive model for personalised care that NHS England has developed with our help is fully referenced.
That means that person-centred approaches and interventions that we, as a coalition, have long championed should be spread to all local areas, including:
- Shared decision making in consultations
- Personalised care and support planning
- Support for self management
- Peer support
- Personal budgets, and
- Social prescribing – access to non-medical forms of wellbeing support in the community
The Plan contains a few specific targets for numbers of people to be reached, but much more will become available soon at the launch of the full vision and action plan for personalised care, of which we are a co-sponsor.
We have reached the point where person-centred care is accepted in policy and committed to implementation. Risks abound, but for now, this must be welcome.
R for radical
The NHS has committed to a shift of resource to primary and community care (integrated with other services and the VCSE). Is it radical enough?
The Plan says these services will have an extra £4.5 billion a year by 2023/24, plus gaining a potential dividend from reducing use of hospital care.
But there are notable pressures that could quickly consume this money: establishing new primary care networks with new service offers; bringing a third of outpatient contacts back into primary care; boosting and retraining the workforce; responding to rising mental health needs; and investing more in rapid community response and rehabilitation.
Still, it’s an important system signal and a clear recognition that for people who most use services (those with long term conditions) primary and community care should be their ‘home’.
O for open and accountable
Here is one of the biggest deficits in the new Plan, and critics such as patient leader David Gilbert (‘gone is any pretence at harnessing community resources’) and local government leader Adam Lent (‘massive community-shaped hole at its core’) have been scathing.
The Plan foresees more integration and coordination between health, public health, housing and local government at both the regional (Integrated Care System) and more local (primary care network) levels.
But absent is any sense of proper engagement of communities in tackling the big health challenges.
We will again see token, rushed ‘engagement’ in the next few weeks as the ICSs (and STPs) nail their new five year plans in place.
There are no apparent plans to subject the Plan as it now is to any further challenge or consultation; to consult on its implications for the NHS Constitution; or to involve the public in securing a new Mandate for NHS England.
Mystery still surrounds the ‘NHS Assembly’ which will start in the spring. What is it for?
V for voluntary sector
The Plan confirms what the Forward View demonstrated: the NHS leadership likes the voluntary sector when it is in Big Delivery mode.
So it is prepared to fund some national programmes delivered by our bigger members on single diseases such as dementia, heart disease and diabetes.
And there is a big chunk of money – £2.3 million – for a new volunteering initiative that, er, nobody appears to have asked for.
There is also recognition (probably due to Public Health England’s involvement) that the sector is important in prevention – though the big prevention programmes in the Plan are traditional single focus NHS ‘offers’ such as smoking cessation for inpatients.
But elsewhere it has warm words and few specifics about additional roles for the sector. Crucially there is nothing about ensuring new money flows from commissioners to the community-based support envisaged for personalisation.
The voluntary sector is promised representation on the boards of ICSs, in the primary care networks and in the NHS Assembly but no-one is yet saying how.
E for equality
The Plan is commendably serious about health inequalities. Clinical Commissioning Group (CCG) funding will be weighted to areas of bigger need, with the CCGs required to show how they target it; and all NHS programmes and local areas have to show the actions they are taking on inequalities.
A new emphasis on ‘population health’, via ICSs and primary care, will better identify local inequalities.
There are commitments to raise the physical health of people with mental ill health. And there is support for targeted schemes for vulnerable groups such as low income pregnant women and rough sleepers.
Disappointingly, there is no mention of the socially and politically unpopular – and most excluded – groups such as recent migrants, sex workers, Gypsies and Travellers.
An overall comment
There are some powerful positives in the Plan but some missed opportunities.
There is virtually no mention of the multimorbidities challenge (people living with more than one long term condition) which is what drives demand, requires new service models, and compounds inequality. The NHS has stuck to its favoured focus on single disease initiatives, clinical outcome drives and technocratic solutions.
The good stuff – on population health, personalisation, prevention and inequality, and a greater role for primary and community care – is not coherently tied together in the way we proposed in our briefing to NHS England.
The big challenges they denote will only be resolved if all these approaches align to target those with the greatest burden of illness and of treatment, and the lowest health literacy, and provide a supportive and enabling approach to increasing their ability to understand and make decisions about their health and wellbeing.