The Government has now set in motion a process to develop a ‘new 10-year health plan for the NHS’.
Among the challenges the NHS faces are the seemingly unmanageable increase in waiting lists and times, a workforce crisis in the care sector generally, and low levels of productivity in the NHS that have not recovered to pre-pandemic levels, with the decline not substantially accounted for by industrial action. Lack of capital spend, obsolete infrastructure – especially analogue systems – and policy, management and workflow issues are cited among the key contributory factors. These are underlined by poor performance on preventable conditions, healthy life expectancy that is actually falling in the UK, and widening health inequalities between the most and least advantaged social groups.
The rapid review overseen by Lord Darzi and published in October was intended to provide the diagnosis and insinuate some key directions to be pursued. The Health Secretary has boiled down the policy priorities (also variously ‘shifts’ or ‘tilts’) to three bullet points that offer serviceable headlines:
- moving more care from hospitals to communities
- making better use of technology in health and care
- focussing on preventing sickness, not just treating it
How to achieve these is now the focus of the admirably concise consultation launched this week.
This process has been described as a ‘once in a generation opportunity to set the NHS on a path for the future’ But it is pitched, often in the same breath, as the response to a crisis. These two objectives – the long term amelioration of healthcare (and public health and social care more generally) and addressing the immediate challenges facing the NHS – do not sit easily together. Still, the depth of the crisis and the complexity of the challenge are both framed as arguments for transformation rather than repair, as the chosen rubric, change.nhs.uk, implies.
Despite the extensive thinking already done in many quarters, it is not plausible that ‘the biggest reform of the NHS since 1948’ should be entirely informed by a process that is timetabled to conclude by the Spring. This can only be a first step. But it mustn’t be a misstep. Here, the political urgency of the current process presents a challenge.
The process needs to be one that engages the groups whose support and compliance will be necessary to achieve the common aims to be pursued. Their engagement is necessary for two reasons. The first is to understand the evaluative background to the evidence that will flood in to the Department of Health and Social Care by 2 December, including the assumptions, definitions and selections that underlie the fetishised ‘facts’ of health policy — metrics, statistics and ‘hard’ data. The second reason is perhaps more important: to lay the indispensable foundation for the cooperation of those with agency and interests at stake. Progress is not guaranteed but will certainly be impeded unless those groups are satisfied that their voices have been heard and their views properly taken into account. Health policy presents characteristically wicked problems; where there is no uncontentious or intellectually compelling solution, procedural justice becomes critical.
Within the six week consultation window, we intend, at PHG, to do our best to contribute positively to this process. We will do this by prompting and gathering reflections from colleagues who share our commitment to improving population health and our particular interest in what responsible innovation of biomarker and digital technologies can contribute.
We are planning to convene an online event on 22 November to help prepare a concerted contribution. We will make an open invitation to colleagues in the genomics and population health research communities and healthcare professionals. Our approach will be framed by the following three points:
- Centrality of data: we believe that the secure and effective generation, processing and exploitation of data across services is fundamental to the future of healthcare, including more convenient, community based and personalised care
- Systems approach: we believe that preventative health care must recognise the interaction and interdependence of three kinds of factor: biological, environmental and behavioural, which means that, from departments of state down, we must overcome siloed thinking and take more systematic approach
- Openness to innovation: as a component of this, we believe that advances in biomarker and genome-based technologies have significant potential, if introduced and used responsibly
The guiding vision should be of a dynamic, learning and innovative health system, shifted towards prevention and tilted to achieve greater equity in outcomes across the population: both will be essential to reduce the overall burden of disease, and promote social justice and a flourishing society.
If you would like to contribute to shaping our input to this process, please get in touch with [email protected].