The scale of the challenges facing the NHS in England is revealed in planning guidance published last week by NHS England. A large number of priorities are identified related to covid and other conditions. The government has provided some additional funding to deliver these priorities, but only for the first half of 2021/22.
The longest section of the guidance, and by inference the most important, is devoted to the restoration of elective care and cancer care, expanding and improving mental health services and services for people with a learning disability and autism, and improving maternity care in response to the Ockenden review. These priorities reflect the backlog of elective and cancer care that has built up in the last year, long standing commitments to achieve parity of esteem in mental health services, and growing recognition of the need to improve outcomes and patient experience in maternity services.
NHS England emphasises that delivering national priorities will require the NHS and its partners to work differently. Among other things, this means embedding digital approaches to patient care, using dedicated fast track hubs for high volume, low complexity care, avoiding outpatient attendances of low clinical value, and rolling out community diagnostic hubs. A new Elective Recovery Fund of £1bn has been established to create incentives to improve patient access to care.
A recurring theme in the guidance is the expectation that NHS organisations will collaborate in integrated care systems instead of working independently. Each of the forty two systems in England has been asked to produce plans setting out how the priorities that have been identified will be delivered and how partner organisations will work together to do so. In the case of cancer care, Cancer Alliances have been asked to draw up a single delivery plan on behalf of each of their systems for the first six months of 2021/22.
The emphasis on the role of systems builds on the response to covid-19 when mutual aid between hospitals and collaboration between health and social care enabled services that were often stretched to their limits to tackle unprecedented demand for care. Equally important was the freedom given to health and social care staff to adapt how services were delivered in the face of huge challenges. All the more welcome therefore that the planning guidance states that systems will be asked to develop their own set of local health and care priorities reflecting the needs of their population.
How much scope there is to do so when the list of national priorities is so long and when the additional funding provided by the government covers the next six months only is a moot point. The impact of covid-19 on staff health and wellbeing will also constrain the speed at which the NHS and its partners in social care will be able deliver what they are now being asked to do. A further uncertainty is covid-19 itself and the possibility that hospital admissions will rise again if there is a third wave later in the year.
Systems are at different stages in their development and some will be challenged to develop credible plans in the timescales laid down by NHS England. Much of the work will be done in the places that make up systems and the provider collaboratives that play a vital role in their work. NHS providers and commissioners will need to redouble their commitments to collaboration and reach out to other partners in local government and the voluntary and community sector as the NHS supports broader social and economic development.
For its part, NHS England needs to persuade the government to provide additional NHS funding beyond the end of September and to continue to make the case for social care reform. Another priority is to grow the workforce through the expansion of training and embracing new ways of working to support transformation in the delivery of care as outlined in the guidance. NHS England must also work with integrated care systems to ensure that the NHS has sufficient capacity to deal with surges in demand for critical care in future—more of the same must go hand in hand with working differently.
The vision set out in the NHS Long Term Plan may have stood the test of time, as the guidance suggests, but there are harsh lessons from covid-19 that need to be addressed. Foremost among these is that a decade of austerity has taken its toll and demonstrates the folly of expecting services to run hot all the time. The NHS and social care need to be better prepared for future pandemics and a sustained investment in public health is needed to reverse the cuts of recent years. Never again should public services be left exposed to events that are not only predictable but were predicted.
Chris Ham is chair of the Coventry and Warwickshire Integrated Care System.
Competing interests: none declared.