The healthmatters blog; commentary, observation and review
We can’t do the same things in the same ways, says NHS Confederation in response to Lord Darzi review
Responding to the launch of Lord Darzi’s review, Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:
“We are at a watershed moment for health and social care and it is important the next steps are the right ones.
“Lord Darzi is right to identify significant action is absolutely essential for social care. An Ipsos Mori poll we commissioned recently suggested 82% of the British public backed a spending uplift in this sector.
“Similarly, we agree that systems need to be simplified, locally led and patient centred with care shifted away from hospitals and into the community. In particular there needs to be more investment in primary care. The new long-term funding deal announced by the Prime Minister simply will not work if we carry on doing the same things in the same ways.”
Today Sajid Javid has announced a government review of medicinal cannabis.
Genevieve Edwards, Director of External Affairs at the MS Society, said:
“It’s a huge step forward that the government is now saying there will be a review into the use of medicinal cannabis – existing evidence of the benefit for MS must be included.
“We already know that cannabis for medicinal use could help with pain and muscle spasms for around 10,000 people with MS. These symptoms can be relentless and exhausting and make it impossible to manage daily life. It’s simply wrong that many people are being driven to break the law under current regulations.”
Responding to the Prime Minister’s speech outlining a long-term funding plan for the NHS, Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:
“The Prime Minister has thrown down the gauntlet and made clear that the NHS and its staff can now help to shape its future. That is hugely welcome.
“The new money represents a major investment guaranteed over a five year period and quite rightly government and society will expect the NHS to deliver. But we must set realistic goals and make clear that there will be hard choices ahead.
“The danger is that we overpromise and under deliver.
“The biggest challenge will be to make sure we do not just put more money into existing services but instead reform the way services are run.
“We are delighted that the Prime Minister remains committed to making sure we have the staff we need, that mental health is properly resourced and that social care gets its own long term plan. On social care, certainty for the future is needed now – without it the NHS plans outlined today simply will not work.
“This sizeable investment falls some way short of the 4% extra-a-year figure the evidence-based independent report we commissioned said was required to meet future challenges. These will still be tough years ahead.”
More doctors will only help if they are distributed across the country and not just sucked into the Golden Triangle of Oxford, Cambridge and London, and they also need to go to the specialties where they are needed -psychiatry, geriatric medicine, acute medicine, general practice. I think we need to look at incentives to distribute staff both geographically and into shortage specialties. As someone who worked as a consultant for 30 years in the north, and is currently on a Trust board in the north, I know first-hand about the inequitable distribution of staff .
Read Linda Patterson’s blog at https://drlindasays.wordpress.com/2018/06/18/welcome-but/
Technologies that empower workers to do their jobs more effectively will be crucial in the battle for greater productivity and employee satisfaction
Organisations operating within the services sector are currently facing a series of challenges, with some being longstanding and familiar, and others brought by more recent geopolitical and technological developments. Key issues such as Brexit, skills shortages and consistently sluggish productivity are squeezing profitability and contributing towards an atmosphere of uncertainty for the likes of facilities management providers and healthcare organisations. However, a greater focus on the deployment of technology in the workplace will offer these businesses the opportunity to completely reshape their working practices and revolutionise key operations. This is according to Kronos.
Despite these evident challenges, the services sector has not yet fully embraced these technologies, meaning many have not yet taken full advantage of the power of comprehensive digital transformation. New technologies such as robotics and autonomous vehicles may be coming to the fore, but organisations also need to do more to acknowledge the availability of other solutions that are designed to help maximise the output of human workers, such as workforce management tools.
On this changing landscape, Gavin England, EMEA Industry Marketing Manager at Kronos, says: “The services industry is up against it when it comes to delivering in the face of current market pressures. Skills shortages mean that businesses are struggling to efficiently move goods and fulfil orders, and the potential impact of Brexit means that there needs to be a major focus on improving operational efficiencies and streamlining core processes, while keeping staff morale high. The pressure to increase bottom-line profitability in the face of such challenges is very real, and one of the most effective ways that this can be done is by empowering managers and employees to do their jobs more effectively with the resources they currently have.”
By placing greater emphasis on the adoption of the most innovative workforce management technologies, England believes that productivity woes can be tackled, and businesses operating in the services sector can offset the impact of factors that are beyond their control.
He added: “The next generation of workforce management technologies are designed with modern workplace challenges in mind, aiming to strip out inefficiencies, automate cumbersome processes, and generally make life easier for managers and other employees. Big data in the workforce, for example, is being leveraged to better understand the needs of employees and structure work accordingly. These tools should be implemented as part of a wider strategy to empower employees and ensure that they feel valued in the work they are doing.”
England concluded: “In a sector in which high turnover of staff and constant shortages of labour are pressing issues, increasing productivity while guaranteeing employee fulfilment and happiness is paramount. Those businesses that lead a proactive approach in tackling these issues will build the most productive working environments, as they will be able to attract and maintain the best talent while ensuring maximum output.”
To discover more about the key issues impacting the services sector workforce and how technology is alleviating these issues, download Kronos’ latest white paper, Empowering the Employee: How technology will play its part in creating a more efficient workforce in the services sector.
Regulators should use discretion when considering whether to withhold extra funding from health and care organisations, the NHS Confederation says in a new report.
The report, System under Strain, shows how increasing year-on-year demand, coupled with flat funding, is not just a winter phenomenon affecting accident and emergency departments.
The report highlights how demand and funding pressures are placing strain on all parts of the health and care system throughout the year.
The membership body is calling on NHS England and NHS Improvement to capitalise on the opportunities presented by their recently revealed plans for greater collaboration.
Both bodies can do this by working more closely with local provider and commissioner organisations on system-wide solutions to address demand pressures, the report suggests.
Linking access to extra funding directly to organisational performance can stand in the way of necessary collaborative action and in effect penalises patients in areas where need is greatest, the report warns.
Niall Dickson, chief executive of the NHS Confederation, said:
“This shows the winter crisis has become the year-long crisis. It shows this is not about one part of a system but a set of interdependent services that cannot operate effectively without relying on each other.
“Without new ways of delivering services and sustained investment, NHS and care services will not simply not be able to cope. We are not currently doing enough for the old, the sick and the vulnerable, and as things stand it will get worse.
“The recent report we commissioned from the Institute for Fiscal Studies and Health Foundation ended the fantasy that we can simply go on with the current system and current funding.
“And it is not just about money. Local providers and commissioners are coming together to find ways to manage growing demand. But they need much more co-ordinated support from the centre. Recent moves suggest this may be about to happen, but we urgently need better ways to support and incentivise new ways of working which deliver the right care at the right time.”
- The goal that 95 per cent of patients should wait no longer than four hours in accident and emergency departments has not been met since July 2015
- More than a quarter of patients (27 per cent) wait 11 weeks or longer to access NHS eating disorder services
- 500,000 ambulance hours were lost in 2015-16 due to delayed transfers of care at hospitals
- The number of 999 calls received increased by 21 per cent between 2013-14 and 2016-17
Boozy blackouts: 2.6 million Britons suffer from memory loss on a weekly basis due to excessive alcohol consumption
Back in April, we shared a guest blog about the Embedding Wellbeing in Northern Ireland project, and the Carnegie UK Trust’s call for participants to receive funding and in-kind support. Now, Aideen McGinley, Chair of the project’s Advisory Group, shares which local authorities were selected, and what happens next.
Today the Carnegie UK Trust has announced the participants of our Embedding Wellbeing in Northern Ireland project. The Community Planning Partnerships working in the following local authority areas were selected to receive financial and in-kind support from the Trust for the next two and a half years:
- Armagh City, Banbridge and Craigavon Borough Council
- Derry City and Strabane District Council
- Lisburn and Castlereagh City Council.
The Advisory Group had the pleasure of reading all of the applications, and I would like to thank all those who submitted. The calibre of the applications was extremely high and the Advisory Group had much to discuss. The successful Community Planning Partnerships were the ones able to show not only that they were working with wellbeing across the Partnership, but also the ones who showed their readiness to engage proactively in taking their work to the next level.
WHAT SUCCESSFUL APPLICANTS HAD IN COMMON
In our analysis, we found a number of common themes across the self-identified successes and challenges, the highs and the lows, of the Community Planning Partnerships in their applications, and are planning to act on this information for the benefit of all.
- Community engagement: some of the Community Planning Partnerships had impressive breadth and depth to their engagement with the local community in the development of their Plans, which has continued into the implementation phase. Their success will be of interest to all Community Planning Partnerships in Northern Ireland, and their counterparts across the UK and Ireland.
- Engagement with young people: the approach taken to engaging with young people by at least one Community Planning Partnership has been recognised internationally as best practice – and will provide invaluable insight into how to involve younger generations in the Community Planning process.
- Partnership working: effective partnership working, shared responsibility, and collective resourcing are key Community Planning principles, which have been demonstrated effectively by some of the Partnerships to date. This success, shared widely, will help to move Community Planning in Northern Ireland to the next level.
WHAT ARE THE NEXT STEPS?
- Sharing the learning: the learning generated by our participants as part of the programme in overcoming their own challenges will be shared with the wider Community Planning Partnership network.
- Peer support: We are developing a peer-to-peer support model that will see our project participants share what they have identified as their strengths to date – whether this be community engagement; working with young people; or partnership working – with the other Community Planning Partnerships who recognised these as their challenges.
- Building on the momentum: the enthusiasm and expertise of stakeholders across Northern Ireland and beyond who have expressed an interest in supporting the project will be harnessed for project participants and the wider Community Planning Partnerships to utilise over the next two years.
- Exploring the challenges: as the challenges of data collection and use were mentioned by all applicants, we’ll follow up on these with the Northern Ireland Executive and Northern Ireland Statistics and Research Agency to find out what can be done to support Community Planning Partnerships to turn evidence into action.
We look forward to working with the three Community Planning Partnerships until 2020, but also to investing our in-kind resources, support networks, and convening power into improving local wellbeing outcomes for all across Northern Ireland.
There are not many heroes in politics.
There are always plenty of aspirants. They try on the cloak. They flaunt themselves. They dazzle for a moment. Then, like Icarus, they fly too close to the sun and they are gone.
But out of the humdrum crowd there occasionally steps someone who makes a real difference. As someone who served 36 years as a Conservative Member of Parliament I would hesitate to describe Aneurin Bevan as a hero, but I have no hesitation in celebrating his achievement in establishing the world’s first universal healthcare system.
Against the background of the developing avalanche of words which will mark the 70th anniversary of the National Health Service we should pause for a moment to recognize just what it meant, in the context in which it happened.
After nearly six years of war and facing profound economic and political challenges both at home and abroad, it represented a commitment that post-war Britain would find the resources to invest in a completely new and untested approach to health policy.
Bevan was committed to free access to care, but his vision went well beyond that. He understood that the purpose of universal healthcare is to secure what we now describe as healthy outcomes for citizens.
He put it this way in his book “In Place of Fear”:
“Preventable pain is a blot on any society. Much sickness and often permanent disability arise from failure to take early action, and this in its turn is due to high costs and fear of the effects of heavy bills on the family…..
“Society becomes more wholesome, more serene, and spiritually healthier if it knows that its citizens have at the back of their consciousness the knowledge that not only they themselves, but all their fellows, have access to the best that medical skill can provide”.
Bevan described these ideas as socialism in action – but I think that understates the extent to which he won support for the principle of universal healthcare that extends well beyond those who would describe themselves as socialists.
Take but one example, The Economist magazine has occupied the epicentre of British liberal thought since 1843, but in April this year it argued in its main editorial that universal healthcare is “sensible, affordable and practical” and that there is a “principled, liberal case for universal healthcare”. The front cover of the same edition proclaimed the objective “Within reach – universal healthcare, worldwide”.
So, when we celebrate 70 years of the NHS, we celebrate the achievement of a man who promoted an idea which has developed its own life – independent of its political roots. It has won endorsement across the political spectrum, and across a wide range of social and cultural divisions, at home and abroad.
When Danny Boyle celebrated the NHS in the opening ceremony of the London Olympics he was celebrating a unique British achievement, but he was doing more than that.
He was celebrating an idea which has the same universal appeal as the Olympic ideal itself.
That is the measure of Bevan’s achievement.
But for us it is not enough simply to celebrate an idea. We can, and we should, acknowledge the vision of those who went before us and recognize our debt to their achievements.
But then we must move from celebration to challenge. We can’t just make the speech; we have to commit to making the hard choices which make the difference between aspiration and reality.
That is why, earlier this year, the NHS Confederation joined with the Health Foundation and the Institute for Fiscal Studies to sponsor their report on funding of health and social care between now and the 2030’s.
Every person in this hall is familiar with the resource pressures facing the NHS and social care. It could hardly be otherwise. Those pressures shape the daily experience of those who work in the sector.
What is more difficult is to stand back from day to day reality and understand long term trends.
That is question which this report addressed.
It has been recognized as the most authoritative analysis since the Wanless Reports of 2002 and 2006 but it is different from Wanless in one important respect. Wanless published two reports, four years apart. The first looked only at healthcare, and the second looked exclusively at social care.
This report acknowledges what we all know – that it makes no sense to look at trends in the NHS separately from trends in social care. Both sectors serve the same communities, and failure in either leads to demand pressures in the other.
More importantly, failure of the NHS and social care to work with each other and the rest of local public services doesn’t just lead to distorted demand patterns; it leads to worse outcomes and damaged lives.
It violates the principles of universal healthcare of which we claim to be the guardians.
So this report looks at trends in health and social care together and it draws two stark conclusions.
First – looking backwards, if allowance is made for the effect of the growing elderly population, it concludes that real per capita spending on health and social care services has not risen since 2010. Not the conclusion of a lobby group, or of a party politician, but the evidence gathered by two of our leading independent commentators on public services and public finance.
Small wonder our services feel themselves to be under pressure.
But that provides the background to the second and most important conclusion I want to highlight from the report. If we are to deliver universal healthcare which meets the needs of our changing population, the authors conclude that there needs to be a commitment to increase taxpayer resources available to both health and social care services at the rate of 4% per annum.
Not 4% for the NHS and a squeeze local government – or a special fund to ease the pressures on social care. But 4% per annum for the NHS and 4% per annum for social care, year on year, between now and 2030.
Hard facts; hard choices.
As we celebrate 70 years of the NHS we should remember that they made a choice in 1948. They chose to be the first country in the world to commit to the principle of universal healthcare and they did so without the evidence which has persuaded The Economist that, at least on this subject, Bevan was right.
We now have that evidence; the question for ministers is whether they act upon it.
So much for money – we shall return to this subject with the authors of the report in the next session – but before we do so we must recognize it not just about money.
When we speak of challenges it is always easier to focus on the challenges which face others – particularly the politicians – rather than address the challenges we face ourselves.
One of the biggest of those challenges which faces every generation of NHS management is the need to ensure that our services are flexible and respond quickly to the changing needs of the communities they serve.
We are all familiar with the problem.
Communities, both inside and outside the NHS, grow used to established ways of working. We make the mistake of thinking that the familiar institutions are the essence of the NHS – we attach our loyalty to the institutions rather than to the values they were intended to deliver.
Good management cherishes the values – but ensures that that the structures change to allow them to be better delivered.
That is what lies behind the development of new structures for accountable and integrated care.
Heaven knows we have talked about it for long enough.
We all know that the individual patient too often experiences our services as a series of disconnected episodes, rather than as a single joined up service.
It may have been unavoidable in the days of black and white television and fax machines. But there is no excuse for it in the era of digital exchange and artificial intelligence.
We sometimes think our task is to introduce new technology to support service delivery. But that is wrong; it is much more fundamental than that. Our task is constantly to reinvent our services to use the full range of resources available to us to meet the needs of our citizens.
That requires new methods of working within the NHS, and it requires new relationships with other partners in delivering joined up public services to local communities.
The practice of universal healthcare is not a monopoly interest of the NHS. Michael Marmot rightly reminds us of the importance of the social determinants of health, and we meet in Manchester which has been pioneering new relationships across the NHS and with elected local government.
Within the Confederation we have been supporting this process within and beyond the NHS, and particularly with the Local Government Association.
Integrated and accountable care is not just a matter of improving the experience of care of the individual citizen – though that should be reason enough to rethink and improve our services.
Failure to implement new working methods across traditional institutional boundaries undermines the effectiveness of our services – and it undermines our commitment to the very principles of universal healthcare.
The foundation of the NHS was a commitment to an untested idea; the best way to celebrate its 70th anniversary is to commit, once again, in the vanguard of testing new versions of best practice.
Which brings me to the people who deliver that best practice, and to one group in particular we should mention this morning.
2018 is not just the 70th anniversary year of the NHS; it is also the 70th anniversary of the arrival at Tilbury of the Empire Windrush and the development of a more diverse and inclusive culture within our country.
To mark that event the Confederation was delighted to sponsor an event last night at which 500 people celebrated the contribution which has been made to the development of the NHS by people with a BME background.
That is important in itself, and no one who was present could possibly have missed the warmth and energy of the occasion.
But it also reflects a bigger truth.
When we celebrate 70 years of the NHS we celebrate a successful organization and a powerful idea.
But what we really celebrate is the ability of the people who work in the NHS to make a difference to the lives of their fellow citizens.
People join the NHS, whether as a clinician, a manager or a support worker because they know that they are joining a team which is dedicated to improving other people’s lives.
That deserves our respect.
Of course there will be times of frustration and times when we fall short.
But the unchanging truth of the NHS is that it is built on the dedication and professionalism of the people who work within it.
So my challenge at the beginning of this conference is simple. We shall discuss money and structures and working methods.
But it is all so much hot air if we don’t connect the discussion with what goes on in the surgery, the things that make a difference to the nurse’s life.
We are all part of the team. We share responsibility for its successes and for its failures.
But it is the dedicated professional people who deliver our services on whom our fellow citizens rely.
It is our task and our privilege to help them make a difference.
NHS Confederation-commissioned research from the Health Foundation and Institute for Fiscal Studies (IFS) sets out strong evidence supporting an increase in spending on social care.
In particular, a funding boost is needed to address inconsistent provision across the UK, and tackle rising numbers of people with unmet care needs which has led to increasing reliance on unpaid care from friends and families.
Securing the future: funding health and social care to the 2030s highlights that spending on adult social care has fallen since 2009-10, despite increasing demand from a growing and ageing population. The report finds that 3.9% annual increases in social care spending would be the minimum needed, just to continue the current level of service provision for projected demand for social care services, which are expected to rise by around £18 billion by 2033–34.
Alongside the Health Foundation and IFS analysis, new polling data by IPSOS Mori for NHS Confederation reveals that 82% of the British public support a 3.9% increase in social care spending.
The new data also shows that 77% of the public support a 4% increase in healthcare spending to help meet growing demand and make some ‘modest improvements’. But social care funding must also rise to tackle problems facing the health service including rising numbers of emergency admissions and patients facing delayed discharges as a result of social care spending cuts.
Since 2009−10, local authorities have faced sizeable cuts in their funding from central government. Many have responded to squeezed budgets by tightening eligibility criteria and concentrating care and support on those with the highest needs. As a result, over 400,000 fewer people accessed publicly funded social care in 2016−17 than in 2009−10.
Differences in needs and generosity have led to large differences in spending per adult in local authorities across England, Scotland, Wales and Northern Ireland. In 2015–16, social care spending per adult was 31% lower in England than in Scotland, a gap which has grown from 19% in 2011–12.
The gap between spending in England and Northern Ireland is even greater.
The report also highlights that the social care workforce is larger than the NHS’s, with around 1.1 million workers in 2016, and to meet projected demand for social care services, an additional 458,000 staff will be required in the next 15 years.
Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:
“We were promised radical reform of social care but yet again nothing has been forthcoming. This has been an area of failure by successive governments which has let down millions of elderly and vulnerable people. Now the delays and dithering have to stop.
“Our report has sparked an important debate among politicians and the public about the future of health and social care in this country and demonstrated how dependent they are on each other.
“It demolishes the idea that the current system and funding levels are sustainable.
“The evidence makes the compelling case that we cannot go on running as we are while the new polling evidence shows the British public agrees. The choice is either significant investment or at best a period of managed decline.”
Anita Charlesworth, Director of Research and Economics at the Health Foundation, said:
“After eight years of austerity our social care services are failing hundreds of thousands of vulnerable people and their families, and the sector is in a precarious state. The government has signalled that it will provide a much-needed funding increase for the NHS, but health and social care are inextricably linked.
“Failure to adequately fund social care, which needs funding increases of at least 3.9% a year, will mean even fewer people receiving the care they need and ongoing inconsistent provision across the UK. This will undoubtedly exacerbate pressure on the NHS, with more and more people with no alternative but to seek help in A&E departments, and hospital beds blocked due to a severe lack of community care.”