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NHS-reform

General Election 2017: Change we can believe in

Thu 18 May 2017

In the second of his election blogs, MiP chief executive Jon Restell calls on politicians to work with staff to switch NHS resources to where they’re most needed – and to be open and honest with voters about what that means.

In this election campaign MiP are asking candidates from all political parties to make four simple commitments to the NHS in England: to fund the NHS and social care properly, to switch resources to where they’re most needed, to support the NHS workforce and to support managers in the NHS. I’m setting out our position in a series of blogposts over the course of the campaign.

My first blog urged politicians to fund the NHS properly. This blog is about how we achieve meaningful change in the NHS and social care. A key question for all parties in this election is, “if you had more money, would you still spend it in the same way?”

There’s a powerful consensus among politicians, NHS staff and other experts that we need to switch resources and do things differently. The most recent expression of this consensus in England was the Five Year Forward View (5YFV), published in October 2014.

MiP warmly supported the vision behind the 5YFV, particularly the emphasis on better prevention and public health programmes, improving care quality and integrating local services, as well as greater efficiency and more funding.

The 5YFV proposed a ‘triple integration’ of services – between primary and specialist hospital care, between physical and mental health services, and between health and social care services. Caring for people with long-term conditions, particularly frail elderly people, is now the main business of the health service. Anyone who has helped an elderly relative to navigate the health and care system knows exactly why it needs to change.

But change is politically tough. People strongly support their local hospital and tend to oppose switching resources towards other services. Even moves to improve hospital services – by pooling resources in specialist centres, for example – meet strong opposition from the public, especially when the new services are not yet visible.

Even when they support change in theory, it’s hard for politicians to go against such strong opposition from their constituents. Proposals for new models of care often seem to come attached to a piece of elastic, which pings back to the status quo when concrete change comes into view.

This is why we need an open, transparent conversation with communities and healthcare professionals. It’s wrong for the NHS and local authorities to plan in private and then try to steamroller change through without taking local people and staff with them.

MiP strongly supports the tests set by NHS England and Healthwatch on how communities should be involved in designing, delivering and joining up services. We also know that unless staff and local managers are meaningfully engaged, we may as well pack up and go home. Nothing will happen without them.

But once – and only once – we have gone though this full democratic process, the case has been made and the tests passed, politicians must get behind NHS staff and take the inevitable political heat that some changes will produce. As NHS England warned in 2014, we need change and more funding. Without both, the result will be some combination of worse services, fewer staff, bigger deficits, and restrictions on treatments.

We’ve made some progress and NHS England has developed some good-looking programmes to improve emergency care, primary care, cancer services, mental health services and patient safety. We’ve seen some innovative investments in technology and bold steps towards integration in some areas.

But it’s becoming clear that our fragmented and piecemeal approach isn’t delivering the change we need. Social care remains in a parlous state and, while welcome, recent increases in funding are simply not enough.

Spending on public health, a critical part of the 5YFV, has been slashed. Despite some progress, mental health is not getting the priority in local plans needed to deliver on the spirit of the 5YFV. Finally, we still lack a comprehensive workforce strategy to support these plans.

We call on all political parties to support meaningful change in the NHS and social care by:

  • Endorsing the 5YFV vision, especially the ‘triple integration’ of services
  • Ensuring that local people have a meaningful say in plans to change services and that robust tests are met before change begins
  • Involving staff, including local managers, more systematically and earlier in developing plans – they have the answers
  • Supporting change once plans have been developed, after meaningful consultation with the public and NHS staff
  • Providing transformational funding to stabilise the system and run new services alongside existing ones for a period of time

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