interviews

A fork in the road for the NHS

Niall Dickson, chief executive of NHS Confederation, talks to NHE’s Josh Mines ahead of Confed2017 about the organisation’s 10-point manifesto for the NHS, and the opportunities and challenges facing the healthcare system.

It’s clear that 2017 will be remembered as a significant year for the NHS. A stressful winter due to historically high demand on health and social care services has politicians and NHS leads scratching their heads for solutions. Integration is being driven by sustainability and transformation partnerships (STPs) – a programme that, despite facing a fair amount of criticism, is still generally seen as the sole option for streamlining acute, primary and community care services. And on top of that, the UK’s decision to leave the EU and the accompanying uncertainty that has come as a result of Brexit has cast doubt over the NHS’s European workforce and threatens to overshadow any debate over the state of healthcare in England. 

Amongst all this, Theresa May’s decision to call a snap election has offered an opportunity for reform as politicians of all persuasions clamber to convince the public that they can be trusted with the health service. It’s in this context that NHS Confederation released its 10-point manifesto for the NHS, which urged politicians to commit to a funding target, publish a white paper on social care reform and deliver commitments to mental health, amongst other pledges. 

Confed17 in the light of a snap election 

During NHE’s interview with Niall Dickson, chief executive of NHS Confederation, he said the general election will be on everyone’s lips ahead of, during and after Confed17. 

“The sun shining on Confed will be the outcome of the election and the issue of who the secretary of state is and who the government will be,” Dickson told us. “Elections have an effect of making people feel it is the start of a period of time, and this is an element of that.” 

It was clear talking to the Confed CEO that the NHS is hitting a major crossroads in the middle of 2017. “There is no doubt that the health service is in a state of flux at the moment,” he explained. 

“The challenges it faces in terms of how it delivers the targets that have been set out in the NHS England document [Next Steps on the NHS Five Year Forward View] are fundamental, and they are, to some extent, about adapting the structures which were set up following the last piece of legislation in 2012.” 

Fundamentally, the key questions for health leaders will be around how the system deals with increased demand which it is currently failing to cope with, added Dickson. Philip Hammond pledged £2bn to adult social care in March, and his party has also committed  to giving people a legal entitlement to take up to a year off to look after close family members who need care. The Conservatives argue that these measures will ease pressure on primary and acute care services by patients being treated in the community rather than in acute settings. 

This is an issue that the new government, regardless of how Parliament looks after 8 June, will have to address, explained Dickson: “Clearly if a new government comes in they may wish to deal with the problems in a different way, but the problem remains the same. 

“We need a more integrated system in which there is less of an incentive in the system to pull people up into the acute sector and more of a system that manages to treat and support people in their own homes or communities – thereby allowing them to manage their long-term conditions themselves and with support in ways that the current system can’t do.” 

But according to Dickson, central to driving integration is also putting aside funding for transformation. He highlighted the creation of the £2bn transformation fund, which was about sending a signal to the system about the commitment to transformation, but added that there is also a recognition that this “can’t be done at pace and at scale unless there is additional funding to help it go forward”.  

The Confed CEO also reiterated that money alone would not solve the NHS’s complex and varied issues. “It’s also about recognition by us and by the service that this is not just about pouring money into the existing system – the system has to change and has to develop and adapt,” said Dickson. 

“But a recognition by the new government to the kind of pressures the system will face not just over the next couple of years but in the longer term – taking us up to 2030 and beyond – is a fundamental issue for us, as a society, to deal with.” 

STPs: the future of primary care 

One of the key strategies that health leaders have put into action since 2015 is the implementation of STPs. How likely these plans will be in achieving their initial goals has been the subject of speculation from numerous health bodies, think tanks and government committees – but one thing that is certain is that they are currently the UK’s option for integrated care, a point Dickson emphasised. 

“Our view is that STPs are far from perfect, but they are the vehicle that does at least offer the potential for different bits of the system to come together and to develop new organisational forms. But, more importantly, to help advance and develop new models of care,” he argued. 

The landscape of primary care in the UK already has taken a different direction to deal with problems facing the NHS. “The traditional model of general practice – of a more isolated individual practice doing its own thing based on GPs working largely on their own – has already, to a considerable extent, gone,” Dickson said. 

And the direction that these new models of care are going in will be in the form of integrated teams with a variety of skills and expertise, the Confed boss added: “It is going to increasingly be that primary care operates across multidisciplinary teams that are much more integrated and involved with other forms of care, and are much more linked in with social care and the voluntary sector.” 

On top of that, proper accountability for those responsible for allocating funds was also highlighted as incredibly important to the success of new models of care. 

“Eventually we need to get to a model which incentivises people to provide care at that level and gives them responsibility,” he stated. “The people supplying money need to be responsible for the outcomes for those patients. ”

Mental health: rhetoric to reality 

Mental health funding is also an issue often talked about by politicians but rarely acted upon practically, Dickson argued: “The first point is that successive governments have produced wonderful pledges about mental health but, in reality, the funding going into it has not matched the rhetoric.” 

And if there was ever a time where rhetoric was expected in abundance, it would be in the period leading up to a general election — but the Confed CEO called on all politicians to move away from buzzwords and into the realm of realistic solutions.  

“We need to be able to demonstrate, as a system, that we are serious about putting the resource into mental health which is required, and that services are redesigned for the benefit of those who are using those services,” he explained. “Some of that again will definitely involve increasing links with the voluntary sector and other innovative providers. 

“We need to have an open mind about how these things are brought about and it will be very interesting how personal budgets, and those kinds of things, land so those individuals are able to exercise greater choice over how resources for them are used. And that, again, is one area where services can and should be developed.” 

The result of the general election will be a decisive moment for the next steps of the NHS, but one thing that is obvious from our conversation with Dickson is that whichever party wins, a number of key problems remain that need solving one way or the other. One solution is money, and lots of it – but also through innovatively and creatively thinking about how the NHS uses its scarce resources in the most efficient and effective way possible.

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