NEWS: NHS Chief calls for proactive reform

As reported by The BMA, NHS Confederation urges political backing for a proactive, prevention-focused health service model to improve outcomes and cut costs

Matthew Taylor (pictured above) used his keynote speech at the organisation’s Confed Expo event in Manchester to urge an incoming government to support such a change and move away from ‘short-termism’, which he says is ‘stifling improvement and collaboration’.

‘Improvement in the health service tends to be about doing things better, but shouldn’t it also be about doing better things?,’ he said.

He says conversations with members had led him to conclude that they seek a health service that achieves ‘ever better outcomes’.

‘At the centre of such a vision needs to be a recognition that our current approach to health policy and the NHS is no longer fit for purpose,’ said Taylor.

‘It’s a time not just for new policies and commitments, but for a fundamental reimagining.

‘We could be at the dawning of the biggest change in the way we think about health policy and the role of the NHS in our 75-year history.

‘Since 1948 our method has been fundamentally reactive. Over the next ten years we could make a decisive move to proactive health.’

 

‘Radical change’

He called out ‘three fundamental issues’ with the current, ‘reactive’ model; that waiting to treat people when they’re sick is not cost-effective, it reinforces inequalities by responding to demand not need, and that people feel less of a sense of agency to improve their health when they feel unwell.

‘Why is it the time right for radical change? Our platform is burning. We face the twin challenges of an ageing population and rising expectations of access.

‘As a society, we are living longer. But we are not living longer with good health.’

He pointed to UK-specific challenges, including that a quarter of working-age people are out of work mainly for health or care related reasons.

‘Add to this modest economic growth and opposition to high rates of immigration and we face the NHS and care system eating up a higher and higher proportion of public spending,’ he said.

‘We see unfolding before us a vicious cycle of higher sickness, lower growth and an NHS stuck in perpetual crisis management.’

He said the Confederation has worked hard to make an evidence-based case for increased health boosting the economy, repeating the much-vaunted research that found for every £1 invested in community or primary care, there was up to a £14 return into the economy.

‘Unless we improve the health of the nation, the NHS will be stuck and the country’s economy flat,’ said Mr Taylor. ‘The failing to act on this irrefutable fact is made more frustrating when important wins can be achieved at relatively little cost.’

‘History tells us that concerted and determined action can make a difference,’ Mr Taylor added, using the examples of removing lead from petrol and banning indoor smoking.

‘Why can’t we do the same, with the same determination, to tackle the obesity crisis?’

He said 40 per cent of the NHS budget is spent on treating preventable disease, ‘yet still too often we measure success in terms of NHS activity, not output’.

 

‘Empower’ the NHS

He said political parties’ policy ‘rarely reflects’ commitments they have made to prioritise prevention and suggested halving the current 18-year gap between life expectancy in the most and least deprived areas should be the ‘centrepiece’ of health policy for the next decade.

Devolving more power and resources to local leaders would ‘empower’ the NHS, local government and other public services to ‘create healthier places across Britain’, Mr Taylor claimed.

He said the public was on board with more money being spent ‘upstream’ on preventative care and that while political parties ‘seem to be listening’ to this notion, their ‘policies and priorities drive in the opposite direction’. ‘Vision needs to be matched by action,’ he said.

Mr Taylor praised primary care for delivering ‘a massive increase in appointments and activity while consuming a smaller share of the health budget’.

But he said there are ‘also stories of perverse incentives’ that lead to practices going bust and GPs left unable to find work.

This, he described as a ‘tragic irony’ in that ‘just as we are starting to appreciate the full potential of general practice and wide primary care… at the same time, in many places, primary is facing existential crisis’.

 

Proactive model

Engaging with patients and the public differently is also key to moving towards a proactive model of care that can be ‘personalised’, Mr Taylor added.

He argued NHS leaders should rethink the term ‘patient flow’, by working towards a model where services ‘flow around needs and lives of patients’.

‘To move from a reactive to a proactive way of working demands a fundamental shift in the way we think,’ he said. ‘The reactive model sees people as collections of body parts, a source of demand; the proactive model values them as human beings.’

With this in mind, Mr Taylor urged an incoming government to look again at the NHS Constitution – with the current consultation on amending it paused due to the general election.

‘The constitution should be renewed in the context of, and integral to, a new plan for the NHS,’ he said.

‘We can inspire to create over the next decade a radical model of health policy and health care. We simply cannot go on with a model that no longer works.

‘I have no doubt that NHS leaders have the skills and commitment to transform healthcare over the next decade. Now, we need national political leadership that shares our hopes and works with us to make it a reality.’