Our correspondent finds much to like in the latest major plan for the future of the National Health Service

Across the entire political spectrum politicians are at pains to assure us that they are fully committed to universal healthcare for all, based on clinical need, and not on age, health, race, or the ability to pay.

As a nation, we should be proud of the NHS; the way that the sick are cared for is one of the measures of a civilised society, and on this particular measure, we rate very highly. As we all know, circumstances have a habit of getting in the way of election promises, so it is reassuring to learn that this commitment remains unwavering, not only within the never-read pages of party manifestos, but as the core value of the people in charge of the NHS.

It is stated with remarkable clarity in the opening part of the new 5-year plan for NHS England, the ‘Five Year Forward View’ (www.england.nhs.uk/ourwork/futurenhs/). If you haven’t read it, I urge you to do so. It is described as the collective view of the NHS leadership, as well as patient organisations and clinicians, of why the health service needs to change over the next five years and how it can be done.

It is a jaw-dropping piece of work that sets out how the widening gaps between the ever-increasing demand on the NHS, quality of care and how it is funded can be closed. On the question of funding alone, the document delivers a major challenge to whichever party finds itself in government after next year’s election.

Change is a must

Funding aside, health professionals will want to know what the future NHS could look like and what their roles might be. The document pulls no punches – major change is an absolute must, it says. But not change imposed by political ideologues who want to mould the NHS in line with party dogma. No, this is change that the NHS is asking for itself to enable it to remain viable.
What is crystal clear is the message that one-size-fits-all is no longer tenable: the status quo of divisions between primary care, community services and hospitals, which have all survived the many ‘reforms’ that the NHS has undergone is “a barrier to the personalised and coordinated services patients need”.

One particular innovation is the “Multispeciality Community Provider” where a wide range of care is provided under one roof

In future, the central task of the NHS will be the care of people with long-term conditions which requires partnership over the long-term, rather than a series of unconnected episodes of care with little, if any, continuity. One of the most important elements of the plan is to strengthen primary care and ‘out of hospital’ services.

Struggling

However, as we all know, GPs are struggling to cope as it is. This is acknowledged, and there will be significant new investment in primary care, including increases in GP numbers, community nurses and other primary care staff.

Community pharmacy gets a specific mention in relation to helping people with minor ailments to reduce demand for GP appointments and A&E visits – it seems that all the things we have been saying about this for years have finally got through.

One particular innovation is the “Multispecialty Community Provider” of extended group practices where a wide range of care is provided under one roof, by physicians, geriatricians, paediatricians, psychiatrists, community nurses, psychologists – and pharmacists – to shift the majority of ‘outpatient’ consultations into the community.

Question

The big question, of course, is how the vision will be delivered. The document tells us how. It is by backing local leadership to find diverse solutions, by aligning leadership across national NHS bodies, by developing the workforce, by improving the use of IT, by accelerating useful health innovation, by ever greater efficiency, and through investment.

Money, of course, is the big problem. The funding commitments announced by the major parties for the NHS over the course of the next parliament are all inadequate. The report tackles this issue head-on: page 37 sets out three possible scenarios that are easy for even the most politically myopic to understand. The bottom line is this: if the NHS is to have any chance of closing the £30 billion funding gap by 2020, an immediate investment in new ways of working and the supporting infrastructure is a must.

It’s a no-brainer: the alternative, of continued ‘budget protection’ with an average productivity gain of 0.8 per cent per year will leave the NHS a catastrophic £21 billion adrift in five years.There are sure to be the usual vested interests wanting to cling to their particular slices of the cake, and they will be joined by the flat-earthers who will no doubt say that the last thing the NHS needs is more change.

But they would be wrong. The plan is ambitious, inspirational, but, above all, practical. It is not based on political dogma, but on the value that has been at the core of the NHS since its inception: quality healthcare for all of us.

Whoops!

Sharp eyed readers may have noticed that I had David (instead of Ed) Miliband as the leader of the Labour party in my November column. This was just a slip. I claim no prior knowledge of developments in this field!

Pen name of a practising independent community pharmacist. Withering’s views are not necessarily those of ICP