interviews

'Ideas whose time has come'

The second report of the NHS Future Forum focused on four key areas where the NHS can drive improvements in patient care and better value services: public health, information, integration and education and training.

Members of the forum met with over 12,000 people, attended over 300 events and received 150 formal responses. They have spoken with patients, carers, local authorities, the voluntary and community sector, NHS providers, academics, managers and health and social care professionals while researching these issues.

Their first report, after the ‘pause’ in the Health & Social Care Bill’s legislative progress, had many of its recommendations adopted by the Government – but also introduced some concepts that haven’t proved hugely popular with either reformers or opponents, such as the clinical senates, whose role has yet to be properly defined.

This second report has focused on the rise in preventable illness and persistence in health inequalities, and the ways in which the health service needs to shift its focus to prevention and supporting self-care.

Patients want more control over their data and communication about care needs to be improved. Cultural barriers to technology must also be overcome. Patient data should be shared electronically once a consent model has been developed to facilitate this, the forum says.

Integration is a major issue and a number of important changes can support local leaders to work together to provide a coherent model of health and social care.

Finally, increased consistency and quality are needed in the field of education and training for the workforce.

Education and training

Sue Slipman, director of the Foundation Trust Network, spoke to NHE just after the report was released.

She said: “I think they’re very interesting recommendations. The area where they’re likely to be most influential is on workforce and education and training. The ideas that are being put forward by the Future Forum are ideas whose time has come in a devolved system.

“There’s clearly a much stronger role for employers at local levels to get together with stakeholders to deliver outcomes on education and training that meets the needs of a modern and changing NHS. It seems to me those are very strong recommendations and we entirely support those.”

The report advises institutions to select for values and beliefs as well as for academic ability, and ensure that trainee nurses actually posses a desire to work in healthcare, following criticism that some nurses lack compassion and the necessary social skills to provide quality care.

It calls on the DH to ensure that all public health specialists are regulated and that transparency and accountability are maintained through the funding for education.

Slipman added: “It’s talking about behaviours and values being part of the recruitment process, not just academic ability. A lot of the changes being made are cultural and that’s got to be reflected in medical and nursing education.”

The Foundation Trust Network believes the changes outlined in this area of the report must be implemented. Slipman stated: “We have to see change in those areas because there’s no longer a centralised system. Clearly commissioners can’t deliver education and training for the workforce.

“This has got to be something where employers build trust with other stakeholders in the system. The professional bodies and the royal colleges have a real stake in the outcome for professions. Employers have to drive this.”

Information

However, Slipman acknowledged that there were some ‘challenging’ things in the report, and a lot of risk related to the changes it proposes. She explained: “Perhaps the most challenging recommendation is around information owned by patients, which has to be right in principle but it is actually a very radical idea.”

The forum wants patients to have clear ownership of their data, and the report makes clear that data sharing is vital for safety, quality and integrated care. This data can then drive further quality improvements and lead to greater transparency of process.

Slipman continued: “What determines information in the system right now is the regulators’ demands. That’s a much more significant determination factor for the way in which information is produced, and that demand will continue in the future. The report is silent on how we’re going to make this transition to patients owning the information. How is regulation going to help and support that to happen? Rather than demanding a parallel and different set of information for regulated purposes.

“In the end it will be the regulators that drive that, rather than goodwill. The report doesn’t have any recommendations about how that should happen. That seems to be the next stage in achieving that objective, to have a look at exactly how the regulators are going to change their information needs to make that happen.”

Integration

Considering the report’s stance on integration, Slipman said: “That is really positive. It is in patients’ interest to close hospital services where organisations are inefficient and are not viable in favour of supporting others to respond to those complex patient needs, for those who require care both in hospital and in community settings. Integrating those care pathways is clearly important and significant.”

However, she warned that this will only happen if a change in the pattern of the way services are delivered can occur – “The problem we have had to date is there hasn’t been the political will to enable those changes to be made,” she said.

The report’s recommendations on this topic include integration around the patient and not the system, as well as making it easier for patients and carers to coordinate and navigate around the health service. The forum suggests that information is a key enabler of integration and by measuring patient feedback, this will allow the NHS to improve its performance.

Additionally, flexibility is necessary for providers to work together, especially with health and wellbeing boards, as well as in the sharing of best practice and for breaking down barriers.

But Slipman said: “Demand isn’t being taken out of the acute and secondary sector by judicious investment throughout the whole healthcare system, and it’s not being done in a way that enables the secondary sector to change their offer and remain a sustainable organisation. There’s a huge amount of risk out there in the system that isn’t being properly managed to help those changes occur. We did a survey some time ago that showed this was about readmission. Even in avoiding readmission into hospital, 50% of commissioners had had no discussions with their providers about where the investment should go and how that could best be achieved.

“If we’re not even at that level of sophistication in the system then I’m not sure how we’ll achieve all of this.”

She suggested that more transparency was necessary to show where investment goes, in order to make judgements about whether it’s working to take demand out of the secondary system. “It’s the worst place we could be, for that money not to be invested properly and not taking demand out of the secondary system, but then punishing the secondary system because they’ve got levels of activity above demand. There’s real risk around the delivery of some of these things and it has to be done with care,” Slipman added.

Public health

The report also suggests that healthcare professionals should make every contact count, and all NHS staff should take the opportunity to discuss public health issues concerning diet, exercise, alcohol and smoking (see case study, bottom).

The NHS should be refocused towards prevention of disease and the promotion of healthy lifestyles in a more holistic sense, the Future Forum recommended. This includes improving the health and wellbeing of the NHS workforce and building partnerships outside the NHS to share learning and best practice.

Slipman commented: “I think it’s right that we use the contacts in order to spread messages but the rest of the world is moving to a nudge culture rather than a bludgeoning culture about these issues. You’ve got to get the balance right in terms of who has the responsibility.

“Certainly you need cooperation around getting the messages out there, using all the agencies who can work together to do that. Clearly health has a big responsibility in the preventative and behaviour agendas but it’s not only a responsibility about health messages, it’s also about understanding people’s health in a more holistic way. And that brings you back to the integration agenda."

CASE STUDY 

NHS Salford is already acting on the recommendation to make every contact count, by working with Salford City Council to provide training for staff to raise discussions with patients at every opportunity.

Melanie Sirotkin, director of public health for the PCT and city council, said: “We are expanding on the initial principles by involving a wider range of staff and by training staff to be able to discuss a wider range of issues that affect health and well being such as lifestyle choices, money, employment and housing. Our aim is for people to be more informed when making decisions that could impact on their lives.”

Cllr John Warmisham, lead member for adult social care and health at Salford City Council, added: “This process is about making sure anyone who has contact with the public is in a position to offer them advise on any health issues and put them in contact with the right organisation to get help. Health and wellbeing affects every area of a person’s life.” 

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