Autumn–Winter 2018 • Issue 2

SOAPBOXNHS Confederation

Autumn–Winter 2018 • Issue 2

SOAPBOX

Ashworth’s acid test

Hancock’s digital revolution

Leading from the front

Social care On life support

Funding Wollaston’s rallying cry

Rural health In focus

Transformation A social imperative

02 Soapbox

ContentsAutumn–Winter 2018 • Issue 2

From the editor03 Welcome to Party Conference

Confed commentary04 Leading a digital revolution

05 A healthier Wales: A vision for the future

06 Northern Ireland: A political vacuum

07 2, 4, 6, 8... who do we appreciate?

Transformation08 We have the roadmap to make the NHS and UK life sciences ecosystem a world leader

09 Unlocking the potential of digital

10 Dying before your time is the greatest social injustice

Economic growth12 Cementing the natural links between health and wealth

Rual health13 Putting the kibosh on the urban-rural divide

14 Dismantling the myth of the rural idyll

15 Finally taking centre stage

Leading from the front16 Why engaging with health and social care staff is mission critical

17 The NHS stands at a critical juncture

Social care

18 Two sides of the same coin

19 Social care on life support

20 An example of politics getting in the way of sound policymaking?

Funding22 Strength in unity

Workforce24 A challenge too grave to ignore

25 Green shoots along a long path

Five minutes with...26 Sharon Hodgson MP

Making a difference27 Moving the dial: How MPs and Peers can play their part

What’s on at party conference28 NHS Confederation at Labour and Conservative party conferences

Soapbox 03

Welcome to Party Conference

Brexit. There – I said it. So now that is out of our system, I want to welcome you to the first edition of our party conference magazine.

Of course, while I jest about the ‘B’ word, I strongly suspect it is the root cause of why I’m increasingly hearing grumbles in the political arena that this is one of – if not the – worst period in recent history for policy creation.

Certainly, the lack of government-led parliamentary business would strongly indicate it has hatched down to weather a foreboding storm, and is not in the ‘tour-the-country-on-a-bus/focus-group-style’ listening mode. Neither is it acting like a statesman with a job to do and ploughing through manifesto pledges like a game of pac-man.

And yet the NHS turned 70 this year, using its birthday wish to hope for a modern, app and patient-driven future – one with more resources to treat the sick and take care of the staff who are there to look after the rest of us. At the same time, social care is in dire need of some political mastery to get it out of the deep hole it has found itself in. In short, now is absolutely not the time for political policy to go into hibernation.

But I then spent some time speaking to stakeholders, policy creators and politicians – inviting them to contribute to the debate in this magazine. I was pleasantly surprised that far from hearing all about Brexit tit-for-tat, I received truly insightful thoughts on issues as far and wide as pharmacovigilance, med tech and rural health.

Indeed, our authors have not shied away from tackling complex health and social care challenges head on, in confrontational debates about social care, the inequity between rural communities and urban medical nuclei, the role of local government in ageing well, the unique landscapes in Wales and Northern Ireland, and the future of life sciences in the UK.

There absolutely is political appetite for getting stuck into health policy in a world that appears very much otherwise dominated with headlines about Brexit and international goings-on, you just have to scratch under the surface. And Soapbox will help you do just that.

A special thank you to our authors for their political determination and personal comment.

“Our authors have not shied away from tackling complex health and social care challenges head on”

From the editor

Victoria Fowler • Public Affairs Manager • @Victoria_Fowler

© NHS Confederation 2018

@nhsconfed

www.nhsconfed.org

020 7799 6666

Portland House, Bressenden Place, London SW1E 5BH

The NHS Confederation incorporates

The views expressed in this magazine do not necessarily reflect those of the NHS Confederation. All information is correct at the time of going to press. Material in this publication may not be reproduced without the express written permission of the NHS Confederation.

04 Soapbox

Confed commentary

Leading a digital revolution

New health and social care secretary Matt Hancock has set out his stall, placing technology at the heart of priorities for a transformed health and care service. David Parkin, senior policy officer at the NHS Confederation, explores the former digital minister’s plans and aspirations, and why a digital renaissance is less choice, more necessity.

Speaking at his inaugural Health and Care Innovation Expo, newly-appointed Secretary of State for Health and Social Care Matt Hancock delivered his six-part plan for a digital renaissance. Gilding his speech with the same praise and admiration for the health service as so many health secretaries before him, Hancock hit upon one of the service’s most elusive beasts – technology.

Technology is not his sole priority: workforce and prevention are his two others. But it is quickly becoming clear that technology will be the yardstick by which he judges his success in the role – and his six goals are key to achieving this.

The six goals are:1. Shared systems that allow NHS systems to

speak to each other.2. Expansion of in-house NHS technology and

eschewing suppliers whose interests aren’taligned with the NHS.

3. Building the best ecosystem for tech in theworld, collaborating on health-tech research.

4. Backing the NHS to succeed and recognisinginnovations at NHS-trust level.

5. Building tech skills into the framework of theNHS.

6. Equipping staff with the right skills to useexisting technology.

Necessity rather than choiceNobody is in any doubt that meeting these goals is less a choice and more a necessity. But the key to their success is not so much if – or when – they are realised, but in whether they are realised in a truly holistic way, as part of a system of staff, infrastructure and, most importantly, patients.

Matt is right – technology does hold the key to meeting a whole raft of other challenges. As he put it in his Expo speech: “the biggest risk isn’t driving digital

transformation; the biggest risk is not driving digital transformation”.

It is clear enough who is driving this vehicle, but what remains to be seen is what this vehicle will end up looking like. While we can be certain that the NHS Ten-Year Plan will undoubtedly contain a bulky dedication to advancing technology, it will require much, much more.

Taking the long viewAs politicians, lobbyists and party activists once again descend on conference halls across the UK in their annual migration out of the Westminster bubble, the question for Hancock is sure to be ‘what will he say on the ten-year plan?’ Mentions of the plan have been peppered throughout all of his speeches to date, but with a prime spot on Tuesday afternoon, party conference is surely the place where it will take centre stage.

Speculation about how the NHS will spend its extra cash is rife. Hancock has identified in the NHS a unique opportunity to combine vast data sets and AI to make our health system the most cutting edge in the world, a ‘greater chance than anywhere else on the planet’, in fact. This opportunity is not one to be sniffed at, and technology has a pivotal part to play in it. But it will take time, money and the sort of continuity that only a ten-year plan can provide.

Lofty goals have been set by the Secretary of State, and if he hopes to get the renaissance he so dearly craves, he will need to pull put all the stops. Can he be the health service’s very own da Vinci? Or perhaps Galileo, with his sights set firmly on the skies? This remains to be seen, but for the time being, a firm, coherent plan on how we get there will do.

“While we can be certain that the NHS Ten-Year Plan will undoubtedly contain a bulky dedication to advancing technology, it will require much, much more”

Soapbox 05

Funding. Money is the hot topic of the moment, with the promise of an extra £20 billion for the NHS in England by 2023. The challenge for the Welsh Government and public service leaders is how collectively, with citizens and partners, we get the greatest value from all our resources to provide services that enhance population health and wellbeing.

Population health and wellbeing depend on much more than the NHS and social care – they come from a good education, decent housing, from employment, lifestyle and the natural environment we live in.

While the health and care system does need more money to cope with increased demand and complexity of illness, if we are truly aiming for transformation, let’s look across all public service budgets and identify where we can use resources better, including digital transformation.

Your support. A healthier Wales is something we can all support. We are keen to work with the Welsh Government to ensure we make the most of the opportunity created by this plan to create a sustainable health and care system that improves health and wellbeing for the whole population of Wales.

We have reached a critical time for health and care in Wales – the points of pressure that regularly affect performance have come together in the last few years. With

increased demand, staff shortages and public health challenges, health boards and Welsh councils are struggling to balance the books. Change is no longer a choice, it is an imperative.

It is into this environment that the Welsh Government released its long-awaited plan for health and social care, A Healthier Wales, in June. After two years of consultation and collaboration through the cross-party parliamentary review process, the plan gives us a national direction and vision, a strengthened executive to speed up delivery, and a mechanism for change in the transformation programme. What more do we need?

Leadership. Without strong leadership across the NHS, local government and political parties, the plan will flounder. It is going to take courage to move the health and care systems onto one path. Political leadership must champion change and take the risks that come with doing the right thing for their constituents. The NHS and local government leadership must widen their focus from individual organisation level to regional and national priorities and solutions.

Action. We now have a vision but there is lots to do to move the vision to reality. In GP surgeries and care homes, in communities and emergency departments, we need to see transformative and ambitious actions that make a difference.

There has always been innovation in the NHS in Wales, but the key now is to take the best of the initiatives and the best of the innovative thinking and, where there is evidence that they work, scale them up across Wales.

Following the release of the Welsh Government’s plan for health and social care, Vanessa Young, chief executive of the Welsh NHS Confederation, sets out what more is needed to turn ambition into transformative action.

A vision for the future

Confed commentary

A healthier Wales

“If we are truly aiming for transformation, let’s look across all public service budgets and identify where we can use resources better, including digital transformation”

06 Soapbox

Northern Ireland Hampered by a political vacuum

The collapse of the Northern Ireland Assembly has left the country in limbo for over 19 months. Yet despite the political uncertainty, the health and social care system has made strides to transform care and services. But there’s only so far health and care leaders can go without political leadership and a long-term funding solution, warns Heather Moorhead, chief executive of the Northern Ireland Confederation.

Health and Wellbeing 2026: Delivering Together, the vision and roadmap for the future of health and social care in Northern Ireland, was published in 2016. Based on the Bengoa

report, Systems not structures, the publication was groundbreaking: it had a clear vision and, importantly, full cross-party support and strong backing from the health and social care community.

But by January 2017, the Northern Ireland devolved assembly collapsed, with no move to date towards direct rule. There has been a political vacuum for more than 19 months.

Civil servants and the leadership across the system continue to make meaningful progress with transformation of services on the agreed policy lines. But without political leadership, it is more difficult to drive some of the challenging or controversial decisions necessary to deliver sustainable change.

Moving things forwardNorthern Ireland already has an integrated health and social care system (the HSC) and our Programme for Government 2016-2021 puts forward an ‘outcomes-based’ approach, setting a strong context for a whole-system approach to ensuring people stay well in their communities as long as possible, and engaging all parts of government in a more collective endeavour.

Additionally, we have a new collective leadership strategy, a new workforce strategy, a plan to invest in elective care centres, investment in multi-disciplinary teams in primary care and investment in a new networked approach to drive quality and safety. And there are several system-wide service reviews and emerging transformation at local level. The HSC is embracing a significant system-wide technology project to support clinical practice, drive efficiencies and improve population health.

Issues to overcomeNorthern Ireland faces the same pressures on services as neighbouring nations – increasing demand, workforce shortages and financial pressures – with an overwhelming need to transform how care is delivered. Like other nations, the system is under immense strain.

In Northern Ireland, health and social care needs are high, with significant areas of deprivation and health inequality. Waiting lists for elective care represent a significant challenge. Workforce issues across medicine, nursing and allied health professions (AHPs) represent a significant constraint, with only limited scope for improvement in the short term. As pay scales diverge across the home nations, there is also emerging concern that Northern Ireland may slip behind, creating further challenges to recruitment. This is not an issue that can necessarily be resolved, as it may require a policy decision.

A key issue is navigating and accessing any opportunities as the system grapples with the outworking of Brexit. This will be particularly pertinent as the impact on cross-border services and communities will be more acutely felt on the land border with the Republic of Ireland.

Leadership and resources are key for the futureThe most pressing issue is to see a restoration of political decision making, to allow health and social care leaders to take some of the tough decisions and to bring the public on board as we seek to redesign services. We have a strong policy base to build on, and members of the Northern Ireland Confederation for Health and Social Care will want to prioritise investment in transformation, addressing workforce issues, harnessing technology and a continued drive for prevention and wellbeing at community level.

There is real momentum, particularly in developing integrated systems that involve primary care. Building on the strong leadership at every level that exists, there is an opportunity to drive complex change. Longer-term funding solutions and political leadership are, however, needed to ensure sustainability.

“The most pressing issue is to see a restoration of political decision making, to allow health and socialcare leaders to take some tough decisions and to bring the public on board as we seek to redesignservices”

Confed commentary

Soapbox 07

It can be hard to find something about Brexit on which everyone can agree. But perhaps one of the great things about this process has been highlighting how much we all love to share health

insight and expertise. Brexit has turned all of us into health policy nerds. Because when it comes to matters like dangerous infections, or rare genetic diseases, or bad reactions to medication, no man – or woman – wants to be an island. Rather, building bridges of communication across the world is in everyone’s health interests. And we are really starting to appreciate these bridges.

Nobody ever escaped a nasty infection, headed out to play football feeling fit and well, and exclaimed in delight: “Thank goodness for the European Centre for Disease Prevention and Control!” But, unnoticed by that football player, the ECDC has unobtrusively been spotting and tracking health threats, alerting the UK, and sharing and coordinating plans to help prevent and control them. That football player’s whole team could have been knocked out by a nasty bug if it wasn’t for the ECDC. It enhances the health of Brits and other Europeans alike without fanfare: ‘ECDC!’ has not yet been part of an enthusiastic chant.

Nor, to be fair, has ‘European Reference Networks!’ ERNs might once have sounded like something too technical to shout about, but since Brexit planning started, people have realised how much they personally care about these networks.

If someone in the UK has an incredibly rare disease, so rare we might not even know how to diagnose it, a disease that hardly anyone else has in the whole world, that person is going to want to find the others. They will want their doctors to talk to each other – and to world specialists – sharing their knowledge in order to improve diagnosis and treatment. The UK is involved in 23 different European Reference Networks which perform that function, enabling people to draw on incredible expertise all across Europe. People who are

lucky enough not to have a rare disease may never have heard of these networks. But people with rare diseases have, and they are already chanting ‘ERN!’

Before Brexit, someone’s eyes might have glazed over at the long and unwieldy term ‘pharmacovigilance’ – or maybe that is just a strange eye reaction to their new medicine. A reaction has never been reported in the UK before, but it did happen in other countries, and since we participate in the networks and systems that report

and analyse these reactions, doctors know to make the link with the medication, so they can take action immediately. That person’s eyes are no longer glazed over, because we currently have a useful and speedy system with data from all across Europe – which makes pharmacovigilance much more exciting than it initially sounded.

There will be many changes to our policies and systems as part of Brexit. Among the many decisions that will need to be made, we must keep a special place in our heads for health. In particular, we must make good decisions about our participation in those many understated but high-impact health systems and networks that give us, as individuals and as a population, the very best chance to thrive.

As Brexit negotiations ramp up, we risk calling time on little-known yet vital systems that protect public health across the UK and EU, warns Layla McCay, director of international relations at the NHS Confederation.

... who do we appreciate?

2, 4, 6, 8...

“Among the many Brexit decisions that will need to be made, we must keep a special place in our heads for health”

Confed commentary

08 Soapbox

gives patients the chance to be involved with developing the latest medicines and vaccines, and upskills our world-leading clinicians.

Early on in my career, I remember speaking with a leading clinician about the impact our HIV medicines were having on him and his patients. He said the introduction of triple therapy meant that patients who had come to his hospital to die were, in a short period of time, now able to go home – and even back to work. Those sorts of stories are so powerful that they never leave you. It’s also the reason why supporting the life sciences sector and the NHS is so important.

What became clear by working together behind a single strategy was that we can drive a virtuous circle that accelerates the adoption of innovation, delivers improved health outcomes for patients and, crucially, improves productivity within the NHS. This strategy will enable us to make life-saving and life-changing discoveries of the future.

This work, and our desire to get the best outcome for patients and public health through Brexit, has brought all stakeholders in the life sciences ecosystem closer together

Something rather remarkable happened last year, and it has the potential to be a long-term game-changer for

the UK.We already have the largest bio-

pharmaceutical research cluster outside the east and west coasts of the USA. It is an incredibly diverse and vibrant ecosystem which connects, among others, world-class universities, medical charities, teaching hospitals and life sciences companies – large and small.

Last year, the sector came together under the leadership of Sir John Bell to create the Life Sciences Industrial Strategy, which sets out a blueprint for the future. Now normally, these type of documents are best described as worthy. This document is different. It is truly remarkable because it provides a world-class analysis of what needs fixing today, and a compelling roadmap to take the UK through a future where the science behind new technologies is advancing at a faster pace than ever before.

At the centre is the NHS and the potential for millions of patients to be research patients, many of whom already benefit from a wide range of clinical trials. This pharmaceutical investment supports the NHS,

than ever before. We are looking for opinion formers across the political spectrum, who also want the same future, to engage in this exciting dialogue and make our NHS and our life sciences ecosystem a world leader. or the next wave of innovation ch

“We can drive a virtuous circle that accelerates the adoption of innovation, delivers improved health outcomes for patients and, crucially, improves productivity within the NHS”

For the next wave of innovation to be truly transformative, the government must deliver the Life Sciences Industrial Strategy in full, explains Mike Thompson, chief executive of the Association of the British Pharmaceutical Industry.

Transformation

We have the roadmap

to make the NHS and UK life sciences ecosystem a world leader

Soapbox 09

T he opportunities of new technology, done right across the whole of health and social care, are vast. Let’s

work together to seize them.” That was the message from new health and social care secretary, Matt Hancock, as he made his first speech in the role at his local hospital in Suffolk.

The breakthroughs he refers to are in artificial intelligence (AI) and new digital treatments. These are quickly becoming commonplace in healthcare, empowering patients, improving survival rates and cutting waiting times. But to fully realise this potential there should be a continued concerted effort to implement new technology.

That has been a key goal of the NHS since Labour’s toxic legacy of failed upgrades left us with the burden of outdated equipment. Even after eight years of investment, fax machines, pagers and Windows XP are still too common a sight in our local hospitals.

But there is hope. Digitalisation under Jeremy Hunt has led to the NHS Spine, a comprehensive database of patient records, while the universal NHS App I called for is currently under development. In Matt Hancock, the NHS now has a tech-savvy leader to build on these foundations. He’s somebody who already uses Babylon’s innovative digital GP service for his own healthcare, and has made technology one of his major policy goals.

That has included everything from ensuring that health information on NHS Choices is available on smart speakers such as Amazon’s Alexa, to a £75 million transformation fund available for trusts to digitise paper records.

As the £20 billion of extra NHS funding is rolled out, there needs to be a focus on using it on investment

in new technology. That’s because there is a great hope that as AI, big data and personalised medicine become commonplace, the overall cost of healthcare can fall. Some estimate that automation could save close to £13 billion a year – around

“

“Automation could save close to £13 billion a year – around 10 per cent of the NHS’s operational budget”

10 per cent of the NHS’s operational budget.

The use of computers for certain health roles will mean more money can be spent on frontline staff, such as doctors and nurses. That’s why I’ve called for these savings to be ringfenced, with a clear commitment to put back every pound saved from back office automation into front line NHS services.

There also needs to be a renewed effort to digitise all paper records, and my call for a paper-free NHS within the next ten years is well within reach.

We are at a defining point for the NHS, with record investment and the rise of new technology meaning the NHS will head into the next 70 years as a renewed organisation. As Hancock says, we just need to seize the moment and embrace the digital transformation.

Alan Mak MP is the author of the Centre for Policy Studies report, Powerful patients, paperless systems: How new technology can renew the NHS, which can be downloaded by visiting alanmak.org.uk/NHSReport

Unlocking the potential of digitalWith record investment in technology, the rise of cutting-edge innovations and a new tech-savvy leader at the helm of the health service, the NHS has a golden opportunity to switch its digital gears, writes Alan Mak MP.

Transformation

10 Soapbox Soapbox 11

those that seem destined to live longer and more comfortable lives. But it doesn’t have to be this way, and this is where politicians can make a difference.

‘Cure-alls’“Cure-alls” in the Victorian pharmacy were just that: ‘cure-alls’ of ill health. They were designed as both a preventative syrup designed to guard against ill health and, astonishingly, a potion to cure all and any illness one fell beholden to.

If this sounds too good to be true, it’s because it was. Indeed, 150 years of scientific and medical discovery, a healthy dose of realism and a commercial and marketing ploy that was essentially flawed, tells us such a medicine could not exist.

Nonetheless, there is a key lesson to be learned and transferred from the apothecary of the 1800s to today’s political and societal world: that trying to prevent disease and tackle ill health when it strikes is a complicated business that requires precision diagnosis, tailored medicines/treatment and an understanding of the environment and history of the patient.

Indeed, understanding why a large proportion of retired men suffer lung conditions will help communities tackle the causes of ill health before it gets to the stage of requiring treatment – perhaps your constituency has a history steeped in industry or mining that years later has resulted in a generation of men with lung cancer.

But of equal importance is recognising areas likely to be affected by strokes or heart disease, loneliness or obesity, and ensuring there are suitable remedies. For example, providing mental health services, strategically placing defibrillators around town, encouraging the use of social prescribing or building community hubs for socialising, exercising, life-long learning and finding employment.

Meeting the needs of local peopleSTPs were invented to empower local communities to design their own local healthcare to meet the needs of local people. There is no place for modern-day “cure-alls” in the way healthcare is delivered. Research proves that it is essential to understand the environments, cultures and whole-person needs of a patient to truly prevent and treat them effectively, in order to eradicate those health inequalities which continue to plague our communities.

MPs, councillors, prospective candidates and party activists alike have worn down shoes pounding pavements, met people of every community, and visited community centres and church halls in wards all across their constituency. This makes them best placed to understand the health needs of populations and they should challenge their STP to meet these needs.

So, to politicians of all persuasions, upon returning to your constituency, book a meeting with your STP lead, ask them about primary care provision, the social prescribing offer, community care, specialist children’s services and targeted interventions based on specific population health needs.

And if they are not up to scratch, or don’t meet the needs of your constituents, challenge their plans, change them, and champion the future of personalised care delivered by our beloved NHS.

“STPs were invented to empower local communities to design their own local healthcare to meet theneeds of local people”

Transformation

Dying before your time is the greatest social injustice

Politicians are well placed to understand the health needs of their local population. Victoria Fowler, public affairs manager at the NHS Confederation, explains why sustainability and transformation partnerships provide a unique opportunity to meet local needs – and why engaging with them is a must for all political leaders.

Transformation

The practice of medicine in Europe has, over time, become the medicine of humanity. Even in the

face of globalisation, cultures and countries hold tightly to their idiosyncratic ways of governing, celebrating culturally significant events and enjoying the foods of their grandmothers.

In this sense, while medicine – the science and practice ofthe diagnosis, treatment, andprevention of disease – hasstandardised worldwide, thedelivery of it varies greatly fromregion, country and, as we willexplore, between counties.

The inception of the NHS, which realised the ambition of equitable access to medicine, resulted – in large part – to providing uniform health services across the country. District general hospitals, widening access to long-established general practice and, even decades later, waiting times reinforced the uniformity of healthcare provision in the UK.

The ambition to offer free healthcare at the point of use was admirable and has resulted in the NHS becoming the UK’s “religion”, as Nigel Lawson most poignantly stated back in 1992.

Tackling the ‘triple challenge’Yet it is rare to find anyone either within or outside of the healthcare (or political) spheres who would

disagree about the disarray, dissipation or desultory results of the Lansley reforms back in 2012. Fast forward to 2016 and sustainability and transformation partnerships launch their local plans.

STPs, as they are better known, are plans drawn up covering 44 footprints in England. Their aim: to help meet a ‘triple challenge’ set out in the NHS Five Year Forward View for “better health, transformed quality of care delivery, and sustainable finances”.

The idea behind them is that STPs provide a vehicle for the NHS to develop its own, locally appropriate proposals to improve health and care for patients. They are working in partnership with democratically elected local councils, drawing on the expertise of frontline NHS staff and on conversations about priorities with the communities they serve.

Addressing health inequalitiesAs a young doctor, Sir Michael Marmot considered it peculiar that a physician should prescribe tablets to treat a patient, only to send them on their merry way – back to the conditions that made them sick in the first place.

Moreover, during his training, he thought it too late to operate on a patient’s lung instead of aiming to prevent the cause.

This young doctor later went on

to study a PHD in epidemiology and now teaches others about the importance of understanding local communities, in order to get to the bottom of life expectancy and living healthy lives from birth to old age.

Contrary to mainstream understanding of why someone may have poor health, Marmot argues that “disempowerment – material, psychosocial and political – damages health and createshealth inequalities”, whether in“low-,middle- [or] high-incomecountries”. In short, it is why figurespublished by the Office for NationalStatistics show that women livingin Cumbria are more likely to reachthe age of 97, while women in NorthWales may only live to 72 years ofage.

Increases in life expectancy for the overall population have been improving since the Second World War owing to a multitude of factors. Namely, this includes improved medicine and healthcare, better diet and living conditions, as well as a decline in smoking and breathing in smog, and injuries caused from heavy industry.

But even within a given constituency, you will find health inequalities – communities which seem destined to live shorter, less fulfilling or less healthy lives and

12 Soapbox

Cementing the natural links between health and wealth

As devolution in England gathers pace, local leaders are increasingly focused on the need to collaborate both economically and socially across their place, not just within their sector. Providing world-class health services is just one part of what the NHS can do to transform the success of our localities, writes NHS local growth adviser Michael Wood.

The NHS operates at the very heart of our local communities and economies, occupying an increasingly important role in driving both economic and inclusive growth. In every part

of the country, the health service will be a huge local employer and procurer, with significant land and assets whose daily work ensures a healthy, productive population. And all the while stimulating new markets for technologies and other innovations.

That’s quite an offer. But there’s much more we can do. A council leader

commented to me recently that the NHS “is only interested when we talk about social care”. What she wanted was the service playing much more of a part in, for example, engaging local businesses in supply chains and inspiring local people into jobs, particularly those leaving school and further education and unaware of the diversity of career opportunities the health service offers.

A renewed community focusMoving from ‘core business’ to a focus on ‘community business’ enables us to tackle these issues in conjunction with other local organisations and over a longer-term period. This shared, place-based approach to financing, resourcing and planning can also bring new opportunities for local partnerships in areas such as housing, technology, transport, research, planning, public health and infrastructure, to name but a few.

Think about big business, too. It becomes much easier for our local colleagues and beneficial for the NHS when life science or medtech firms can co-locate with NHS trusts and when we can help upskill and grow their workforce.

The NHS belongs at the tableTo turn a well-worn phrase on its head, “you can’t have a strong economy without a strong NHS”.

As public services struggle to adapt to the new financial and demographic landscape, there is a growing understanding that service transformation is inherently linked with economic development. Many of the ideas sketched out in the NHS Five Year Forward View, such as ‘test beds’ of innovation and healthy towns, are great examples of this.

There are a growing number of examples up and down the country of NHS organisations shaping the future plans of their local enterprise partnerships and local and combined authorities, cementing the natural links that exist between health and wealth. Next time local partners are sitting down to discuss the future of your place, have a look around the table – is the NHS there?

“You can’t have a strong economy without a strong NHS”

Economic growth

Soapbox 13

Putting the kibosh on the urban-rural divide

Rural health

The entire NHS is under unprecedented strain, but rural health services in particular are facing a unique set of challenges.

People living in rural areas continue to suffer from awful ambulance response times. NHS England data shows that in many categories, the East of England Ambulance Service – covering rural Norfolk and Suffolk, my constituency – is the worst performer in the whole country.

Rural communities are constantly disadvantaged by ambulance trusts being held to account for their performance across a whole region. This incentivises trusts to focus on hitting targets in urban areas with large numbers of patients, even if performance is dire outside the towns and cities. This then perpetuates a stark postcode lottery in access to emergency care, which the government and regulators have failed to get to grips with.

Reorganising stroke servicesWe must also make sure that stroke services in rural areas meet the same standards as those in London and Manchester, where there has been a drive to centralise stroke services into centres of excellence providing 24/7 world-class care. There are understandable

concerns, particularly in remote communities, that this could mean some people having to travel further for treatment. But the evidence is clear that reorganising services in this way can potentially save thousands of lives and prevent life-long disability, so we urgently need to make progress on this.

A role for social enterprisesOn top of the difficulties in the NHS, there are major challenges facing social care in rural areas, where it is hard to recruit care staff on low incomes, and where travel costs make it more difficult for providers to operate. I believe there is a huge role for not-for-profit social enterprises operating in rural areas, where all staff have a stake in the organisation.

Raising resourcesThe bottom line is that we desperately need a national discussion about how to guarantee sustainable funding for the NHS and social care. I have called for a dedicated NHS and Care Tax to raise resources on the scale needed. But any future funding settlement must also recognise the higher costs of delivering health and care in rural areas. It’s intolerable that access to these vital services are too often determined by where you live, which is why it is high time that the government makes it a national priority to end the rural-urban divide.

Does access to emergency care, stroke services and social care really differ depending on where you live? Norman Lamb MP, co-chair of the All-Party Parliamentary Group on Rural Health and Social Care, says it is high time the government made parity between rural and urban communities a priority.

“Any future funding settlement must recognise the higher costs of delivering health and care in rural areas”

14 Soapbox Soapbox 15

A new cross-party inquiry aims to pull rural health and social care out of the shadows, kickstarting a step change in how people access care and services. Anne Marie Morris MP, chair of the inquiry, tells us more.

Health as an issue in England is

the urban perspective. Current practice across the country is based around urban populations and generates a one-size-fits-all approach. Such

an approach invariably neglects the needs of rural communities across the country and places them at a disadvantage when it comes to catering for their health needs.

At the beginning of July 2018, the pioneering new National Centre for Rural Health and Care was formally launched in Lincoln at Bishop Grosseteste University. I have been in conversation with the centre as it has developed over the last two years, and I am delighted to announce I will be chairing its cross-party parliamentary inquiry into rural health and social care.

The inquiry will look at the key issues facing the country in providing good quality and effective health and social care in rural settings. There is scope for this project to

bring about real change to the way people living in areas like ours access health and care services, and I greatly look forward to chairing the review.

Both the National Centre for Rural Health and Care and the parliamentary inquiry will enable us to gather evidence of good practice that is already taking place in rural communities across the country and allow us to look at how it can be distributed and used in other communities. While a one-size-fits-all approach doesn’t work for the healthcare system, it is important that different areas continue to look and learn from each other.

It is imperative that rural communities are not left behind when it comes to conversations on the future of healthcare models across England. I will continue to be a strong voice for the health needs of rural communities, especially my own area in Devon.

Finally taking centre stage

Rural health Rural health

“The inquiry will look at the key issues facing the country in providing good quality and effective health and socialcare in rural settings”

At the extreme end of service withdrawal, life in the countryside isn’t always all it’s cracked up to be. Liz Saville Roberts MP puts this in sharp focus, urging fellow MPs and policymakers to push rural health needs into the spotlight.

Countryside communities are celebrated as rural idylls, but appearances deceive. On the one hand, there is an assumption of

wealth, health and good fortune – retirees escaping in the autumn of their lives to a tranquil backwater, among local people fortunate to be blessed with fine views and stunning landscapes, whose lifestyles are far removed from the urban rat race.

On the other hand, rural communities are at the extreme end of service withdrawal, as every public body – health, social care, leisure, education and policing among them – weighs the scales of population density against chronic austerity budgets. And, with impeccable individual logic, retreats to urban centres.

At a constituency surgery this summer, a man from a south Gwynedd community told me how his wife was sent to Ysbyty Bronglais

in Aberystwyth to treat ulcerations on her leg. He explained that, because he couldn’t drive, he would use public transport to visit her. This is a distance of 30 miles and accessible by either train (an hour’s journey, one change) or bus (one-and-a-half hours, one change).

Clinicians at Ysbyty Bronglais decided to send his wife to a specialist at Morriston Hospital, Swansea, 100 miles away. While she was there, the distance, transport times and ticket costs meant it was impossible for her husband to visit. She was so distressed by her circumstances that she refused to consent to treatment and was eventually returned to Aberystwyth, where complications resulted in her leg being amputated.

Poor public transport, alongside the hidden costs of transport,

have a direct impact on patient experience and outcomes. And this is combined with an ageing population, including people moving away from their family support networks to retire, and increasing difficulties in the recruitment of clinical and social care staff.

I beg the politicians and professionals responsible for planning the future of medical care to recognise the reality of rural deprivation and health needs.

Dismantling the myth of the rural idyll

“She was so distressed by her circumstances that she refused to consent to treatment and was eventually returned to Aberystwyth, where complications resulted in her leg being amputated”

predominantlyseen from

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Leading from the front

Why engaging with health and social care staff is mission critical Just days after his appointment, new health and social care secretary Matt Hancock set out his stall on the NHS, identifying technology and workforce among his key priorities. Two months on, a new digital platform aims to harness the power of both, giving health and care staff a say in day-to-day policy creation. Matt Hancock MP explains why kickstarting this national conversation is key to shifting the needle.

Our NHS is the beating heart of our nation, and our dedicated 3.1 million health and care staff are the oxygen which gives it life. From cleaners to consultants to

chief executives, everyone who works for the NHS contributes to saving lives and improving lives every day. To get the most out of our NHS and make it the very best it can be, it’s mission critical that we give everyone the chance to the do the best they can.

Staff at the heart of policy creationAt one point or another, health and care staff have been there for us. They’ve been there for me. They do it for everyone – day in, day out.

That’s why in my first speech in this job, I set out my early priorities and what I want to do to engage with the 3 million people who dedicate their working lives to caring for others. Because the fact is, making the NHS the best it possibly can be can’t be done in a top-down way. It’s time we heard from health and care staff about what they really have to say about the jobs that are at the heart of this country. Nobody knows what needs improving more than hard-working staff themselves.

To this end, we’ve launched Talk Health and Care, a new digital platform to give the people who work in the NHS and in social care in England a voice in

the day-to-day creation of policy. And giving staff somewhere to go with their ideas and questions; somewhere for them to challenge us and, equally, for us to ask something of them.

“Making the NHS the best it possibly can be can’t be done in a top-down way.”

While the NHS is developing more ways to prevent and reduce violence against health and care staff, Talk Health and Care will seek views on what needs to be done to make staff feel safe and secure at work.

Talking and listeningThe response has been terrific. Within the first few hours it had thousands of engagements from staff pitching in with what they thought was needed to make our NHS better.

I’m delighted with this response, but it won’t stop there. I want to keep talking, and keep listening. I want our workers to innovate, and I want my Department of Health and Social Care to innovate, too. Part of that means trying new things, learning as we go, and improving where possible.

Working in the NHS is not just a job – it’s a mission. As health and social care secretary, my mission is to harness that passion and support our incredible health and care staff to make the NHS the very best it can be.

“Working in the NHS is not just a job – it’s a mission”

Soapbox 17

The NHS Ten-Year Plan will be a defining test of whether this government can deliver the

improvements patients want to see after nearly a decade of squeezed budgets and pressure on services.

It’s clear our NHS and social care sector need a long-term plan – it’s what I’ve been calling for since I became the shadow health secretary in 2016. And I will continue to engage with and listen to all members and partners of the NHS Confederation, as a central voice in the debate about whether the government’s plan will work.

Five key testsAs the details become clear this autumn, Labour is demanding five key areas where government ministers must improve.

First, the funding test. Public health and training budgets have been cut and capital budgets raided. The ‘sister service’ of the NHS – publicly funded social care – has suffered swingeing cuts of £6.3 billion.

So Labour’s commitment is a fully funded NHS and social care service to fulfil the obligations legally enshrined in the NHS Constitution and to improve the quality of care for the future.

Secondly, staffing. We have a vacancy gap across the NHS of

100,000. A credible plan to deliver the staff our NHS and social care sector need will be a key test of the government’s plan.

They should start by bringing back the training bursary for nurses and allied health professionals and abandoning Theresa May’s restrictive so called ‘hostile environment’ visa regime, which has denied so many hospitals access to the very best international clinical staff.

Our third test is on the way in which care is delivered. By 2020, the population of over 65s will grow to 15.4 million. The number of over 85s will double. As we live longer, the disease burden changes too.

But when faced with demographic changes and the need to help people manage long-term conditions like diabetes, we should consolidate not fragment. Healthcare should be delivered not on the basis of markets, but on partnership and planning.

So our third test is whether the government will scrap the Health and Social Act, end fragmentation, end privatisation and instead move towards genuine integration, coordination, planning and partnership.

And we know that the NHS is still too reliant on decades old machinery. Over the coming years, artificial intelligence, bespoke nutrition, robotics, digital health technologies, the internet of things – where 50 billion devices will be connected in the next 25 years – will all offer huge opportunities for improving health outcomes in the future.

So our fourth test is whether the government will sufficiently invest in the infrastructure of our NHS, renew existing equipment, clear the multi-billion pound backlog of repairs and ensure we access the innovative technologies of the

future, while banning capital to revenue transfers.

Finally, on health inequalities, it should shame us as a society that advances in life expectancy have begun to stall and, in some of the very poorest areas, are going backwards.

We’ve seen a rise in admissions to hospital for malnutrition since 2010, a rise in the number of pregnant women admitted to hospital with Vitamin D deficiency.

Child poverty is on the increase and we know there is a correlation between poverty, deprivation and relatively poor child health outcomes.

“Healthcare should be delivered not on the basis of markets, but on partnership and planning”

So an overarching strategy for tackling the wider social determinants of poor health and wellbeing is our final test.

That means measures to improve the quality of air we breathe and the standards of housing many live in. It means an all-out mission to improve the health and wellbeing of every child. And it means expanding not cutting public health and early years provision too.

Hitting ‘reset’The NHS stands at a critical juncture. In this the 70th anniversary of the NHS, the heath secretary has a chance to reset the trajectory of the last eight years.

A quick fix or fudge won’t do. We need a long-term plan for our NHS and social care sector. Labour has set out our vision to deliver it – our challenge to the government this autumn is whether they can match that ambition in their long-term plan.

The NHS stands at a critical juncture

Leading from the front

With a ten-year plan for the NHS in the pipeline, shadow health and social care secretary Jonathan Ashworth MP sets out five key areas the government must tackle to deliver a sustainable health and social care sector.

18 Soapbox

As this year’s party conference season gets into full swing, the health and social care system

finds itself at a potential crossroads. Back in May, the Institute

for Fiscal Studies (IFS) and the Health Foundation published a report, commissioned by the NHS Confederation, which sought to move the debate about NHS and social care funding forward.

Securing the future: Funding health and social care to the 2030s provided the clearest and most compelling analysis to date of the demographic and demand pressures facing this country over the next decade and beyond. It was a wake-up call to all the political parties and indeed to the wider public. The message was unequivocal – if we want to have decent levels of provision, we will need to increase funding for both health and social care by an average of 4 per cent per year above inflation each and every year to 2033.

This may seem a huge amount but in health spending, it broadly reflects the historical trend we have seen since the end of the Second World War and the trends in other developed economies.

The UK government subsequently promised to increase NHS funding by 3.4 per cent a year on average over the next five years in England and to provide proportionate increased funding for the devolved administrations’ budgets.

But it has again delayed an announcement on social care funding in England, which is now not expected until the Spending Review next year. And, yet again, it has postponed the promised green paper which is supposed to produce a long-term solution to social care sustainability.

This has left the organisations we represent – which includes commissioners and all types of

Without a solution to the social care crisis, the potential progress from increased NHS funding will be put at risk, warns Niall Dickson, chief executive of the NHS Confederation.

providers of NHS services – and our partners in adult social care in a difficult place.

Falling shortWe are not quite there on NHS funding – it falls some way short of what the Securing the future report said was required. It has also been calculated based on an increase to NHS England’s budget, which excludes areas such as training, prevention and capital. In England too, we are certainly not there on social care funding, with the cross-party Local Government Association warning of “an immediate and annually recurring funding gap of £1.44 billion”.

Without a solution to the immediate and long-term issues of social care, we will risk undermining the potential benefits that should flow from increased funding for the NHS. The two services are interdependent – with one being broken, the other will not thrive.

“Without effective social care, the pressure on our A&E departments, our clinics and wards will continue to grow to the point where they simply cannot cope”

The greatest challenge facing the NHS is growing demand, most of it from growing numbers of older people with multiple co-morbidities. Without effective social care, the pressure on our A&E departments, our clinics and wards will continue to grow to the point where they simply cannot cope. There will not be the places to treat them and there will be no places in the community to transfer those lucky enough to have been admitted.

Golden opportunity We have three opportunities over the next 12 months:

Social care

Two sides of the same coin1. To agree a coherent ten-year

plan for health and care in England, which sets out a roadmap for the next decade. A plan for one without the other is not going to be an effective plan.

2. To secure funding to address the crisis in adult social care in England and devise and agree a long-term solution that puts adult social care on the firmest possible footing.

3. To transform care so that we can meet the needs of a changing population, providing care at theright time and in the right place – often that will mean more care closer to home.

To realise these opportunities, we need support from the political parties and their leaders to:

1. Make sure the ten-year plan for England is shaped in partnership with those who deliver care as well as the public and partners across health and care, including all those who commission, provide and, most importantly, use these services.

2. Make sure there is no further delayin acting on the crisis in adult social care.

3. Ensure all plans are tailored to the needs in the devolved nations, recognising the already integrated systems in Wales and Northern Ireland.

4. Provide a solid foundation to improve and expand NHS-funded mental health services.

5. Support our members as they work to transform health and care services locally. This may include fronting up difficult decisions about the future shape of services, including closing some and refocusing others.

We now have a chance to create a health and care system fit for the 21st century.

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Social care on life support

If I have one wish for the autumn 2018 party conference season, it’s that the political parties at national level mirror the

approach taken by the political leaders of local government on the crucial issue of the future of adult social care and support. At the Local Government Association (LGA), local politicians are loudly unanimous that we must act urgently to address the crisis facing adult social care. And we must find a solution that can be supported across the political spectrum.

Short-term cash injections have not prevented care providers from closing their operations or returning contracts to councils, resulting in less choice and availability to a rising number of people with care needs. There are 1.8 million new requests for adult social care a year – the equivalent of nearly 5,000 a day. This is increasing the strain on an already-overstretched workforce and unpaid carers, and leading to more people not having their care needs met.

We were hugely disappointed that while the NHS got a £20.5 billion-a-year birthday present for its 70th anniversary, adult social care got yet another delay in the long-awaited adult social care green paper.

Taking matters into our own handsTo support the government’s green paper on the issue when it is published in the autumn, we recently launched our own green paper and with it a major public consultation. Throughout the summer, we have been taking soundings from a wide

With adult social care in England in crisis, Cllr Ian Hudspeth, chair of the Local Government Association’s Community Wellbeing Board, says local leaders must be given the time, space and trust to work together to improve the health and wellbeing of their local residents.

range of people and organisations from across society on how best to pay for care and support for adults of all ages and their unpaid carers, and it aims to make the public a central part of the debate. The LGA will respond to the findings in the autumn to inform and influence the government’s green paper and spending plans.

Alongside funding issues, we have also sought views on how to shift the overall emphasis of our care and health system so it can be made to work better as a whole. This

requires a fundamental rebalancing of priorities – moving away from treating long-term conditions and illness caused by ageing and lifestyle factors and moving towards community-based models of both early intervention and support.

There are huge benefits of health and social care working more closely together, particularly in terms of NHS community-based services integrating with adult social care. It could also help to manage pressures on public spending more effectively.

This would help maximise people’s health, wellbeing and independence for as long as possible, and continue to take a whole-person and whole-family approach to those who develop support needs.

In it togetherWe have many of the key ingredients that are needed to help bring about this shift and focus investment in low cost prevention and support to help bend the demand curve for high-cost healthcare. Under councils’ stewardship, we have a

better performing and more cost-effective system of public health. We have significant new funding for the NHS. In health and wellbeing boards, we have a means of joining up clinical, professional and service user voices. We have led the way in re-designing services with – not for – residents, and we work imaginatively with provider organisations and the third sector. And, most importantly, we have democratic accountability through

local councils. We’re clear that we are in this together with our health partners.

We need national politicians to give local political, clinical, community and professional leaders the time, space, trust and respect to work together to develop our own shared priorities for improving the health and wellbeing, and care and support of all our residents to help them live independent, valued and fulfilling lives.

Social care

Some figures which illustrate the scale of the crisis facing us:• Since 2010, councils have had to bridge a £6billion funding shortfall just to keep the adult social care system going. They have done this by reducing funding to other vital council services, such as parks, leisure centres and libraries, which themselves help to keep people well and from needing care, support and hospital treatment.

• In addition, the LGA estimates that by 2025 adultsocial care services will face a £3.5 billion funding gap to maintain existing standards of care.

• Our analysis of council tax spends estimates thatin 2019/20, 38p of every £1 of council tax will go to adult social care. In 2010/11, this was 28p.

Soapbox 21

No BBC Question Time discussion about the NHS is complete without a well-meaning member

of the public or applause-hungry panellist chiming in with: “The NHS shouldn’t be used as a political football”. I’ve never understood this saying.

Decisions about who gets health services, how they are paid for and which services are available cannot be anything other than an expression of politics. And no country, regardless of whether it has a state-run, private or mixed health system, has managed to make healthcare non-political – and nor should it try.

The big political debate about the NHS has largely been won. And the fact that it is by and large free at the point of use to all is broadly a point of consensus. The same cannot be said of the NHS’s sister service, social care...

Spare a thought for social care. While the NHS was out celebrating its 70th birthday and unwrapping its present of extra funding, adult social care was sat at home, with the lights turned off and the heating turned down. People were not wearing ‘I love social care services’ pin badges or writing articles about how social care was the thing that made them most proud to be British.

NHS Confederation policy manager Matthew Macnair-Smith takes aim at the stalemate engulfing social care, asking what’s holding politicians back from developing a shared solution to the social care crisis.

An example of politics getting in the way of sound policymaking?

Social care Social care

More importantly, policymakers and politicians were not making any plans for social care over the next decade. In fact, the much-anticipated green paper has been delayed yet again, this time to ensure it aligns well with its more popular sibling’s long-term plans.

A costly moveOver the years, policymakers and politicians have tried to answer the social care question. Since 1998, there have been no less than 12 green papers, white papers and other consultations, and no fewer than five independent commissions attempting to find a way to make social care sustainable. Not to mention the proposal put forward in the 2017 Conservative Party manifesto.

But it seems whatever proposal is put forward, politics fails to supply the leadership or communication necessary to build enough support to bridge the divide and agree on a course of action. And while politics fails, pressures haven’t abated, with recent Local Government Association (LGA) figures stating that adult social care faces an immediate and annually recurring funding gap of £1.44 billion. This means an increasing number of people are not getting the help they require, leading to increased demand on hospitals and more costly acute care.

So, what’s holding us back from coming to a shared solution?

One suggestion is a lack of political bravery. Some would argue that Theresa May’s manifesto pledge to introduce a cap was a prime example of such bravery. And it is broadly accepted that, for some, it would have resulted in a more generous system than the one currently in place.

Yet the largely negative public reaction to May’s proposal tells us two things. Firstly, the way solutions to the social care question is presented is hugely important. And secondly, people’s understanding of the current social care system is often poor. The difficulty with the presentation is that whatever policy solution might be practicable, it must also be seen by the majority of voters as being fair.

This means it needs to be seen as fair not only towards older people who have paid taxes all their lives, but also to those who want their

homes protected to hand down. And it must also be seen to ensure some level of fairness across the different generations. Without this, as we saw in 2017, policy can easily be decried as an unfair ‘dementia tax’.

A better and fairer systemThe second obvious point is that the majority of people have to agree that the policy being put forward creates a better and fairer social care system than the one currently in place. This is particularly hard because misunderstandings over how the system works are

widespread. Many people are shocked to find that they may have to contribute towards their own care costs. This lack of understanding and difficulty in explaining changes are at least partly responsible for a lack of momentum for driving long-term change.

It is likely that if and when the government’s social care green paper comes out, it will propose a cap of some sort. Importantly, the Labour Party has proposed that alongside the introduction of National Care Service, at a cost of £3 billion per year, there would also be a cap on costs. So, we may finally have some level of political consensus on the issue.

The only major challenge may now lie in the uniquely tribal and combative nature of British politics, which means that for some, whatever solutions are alighted on by one tribe, they can never be endorsed or approved by the other. We need politicians to forget this mantra and find an acceptable way forward to solve the question of how to sustainably fund social care over the long term.

Blowing the final whistleTo do this, public and political attitudes towards social care need to change too. In short, we need social care to stop being a political football – there, I said it! – and for consensus to reign about its importance and value to people, in the same way the NHS does. Achieving this won’t be easy, but politics should never get in the way of sound policymaking.

“Since 1998, there have been 12 green papers, white papers and other consultations, and five independent commissions attempting to find a way to make social care sustainable.”

24 Soapbox

The NHS is a people organisation. In both its values and delivery, it is fundamentally driven by the

care, commitment and compassion of people, for people.Within mental health services – where a meaningful humanconnection can often have aprofound influence – these person-centred principles are all the moreimportant.

And yet we know that within the NHS, our workforce is facing unprecedented challenges.

Recent data published by NHS Improvement shows that NHS trusts in England have around 100,000 vacancies. Nursing vacancies are at an all-time high and 8 per cent of all medical roles are currently unfilled. Mental health services are feeling this pressure more than most, with 12 per cent of mental health doctor roles now vacant.

New health secretary, Matt Hancock and NHS England chief executive, Simon Stevens, have both reinforced their commitment to addressing the workforce challenge,

A challenge too grave to ignore

“Nursing vacancies are at an all-time high and 8 per cent of all medical roles are currently unfilled”

“With the evolution of less traditional roles, we’re already seeing the benefits of greater flexibility within our services”

particularly within mental health. This is, of course, very encouraging and I look forward to this being a key focus in years to come?

For me, we have two very simple questions to answer: how can we better support our current workforce to meet these challenges; and how can we ensure that a future workforce model can maximise traditional roles, while embracing new roles and the different approaches they bring?

I jointly chair a workforce advisory group within the NHS Confederation’s Mental Health Network. Last year, this group supported the development of The future of the mental health workforce report, which confronts these two questions.

It highlights the importance of truly understanding the needs of our population. This cannot be done through the lens of just one organisation, service or demographic. To get this right, we need to work with our health and social care colleagues, in partnership with our local communities, to identify the skills required to develop a workforce built around these needs.

We know that the NHS’s future workforce will undoubtedly come from a very different place. With the evolution of less traditional roles (such as nursing associates

and peer support/lived experience workers) we’re already seeing the benefits of greater flexibility – based on the needs of our communities – within our services.

These exciting new roles represent the opportunities ahead if, as a system, we can take an approach that is agile to the changing needs of our population, while also supporting our colleagues to be the best they can be, so they can continue to form meaningful human connections with the people we serve.

The NHS in England is facing a worrying shortage of staff, with mental health services feeling the pressure more than most. Sheena Cumiskey, chief executive of Cheshire and Wirral Partnership NHS Foundation Trust, considers how to turn the corner, and why partnership working holds the key.

WorkforceWorkforce

22 Soapbox Soapbox 23

Funding

Strengthin unity

children now three times as likely to be obese. Our joint inquiry with the Education Select Committee into children’s mental health heard that only a quarter of children who need mental health services receive them. And our inquiries into the potential impact of Brexit highlighted the additional risk to health and social care that would follow, especially from a no-deal exit.

Every headline we see on health and care underlines the urgency of a lasting funding solution, to provide realistic, joined-up and stable levels of investment. These are difficult questions to resolve and my experience both as chair of the Health and Social Care Committee – and also as co-chair of the jointsocial care funding inquiry and aschair of the Liaison Committee– has convinced me that cross-party working towards solutions isessential, and is also possible.

In March 2018, over 100 MPs from across the political spectrum, including 21 select committee chairs, wrote to the Prime Minister urging her to set

up a Parliamentary Commission on Health and Social Care which could build support for reforms in parliament and report in a timely fashion. Our social care inquiry saw 22 members of different political parties, representing very different constituencies, coming together and agreeing a framework for social care funding, one of the thorniest issues facing politicians today. Our social care citizens’ assembly also drew together a representative sample of the population, and despite coming from very different backgrounds and standpoints, they too were able to grapple with extremely complex issues and reach a consensus.

Grasping the nettle We have a new Secretary of State and a promised increase in funding for the NHS. But, welcome though that extra funding is, it is also essential to secure funding increases for public health and social care – not only are these essential aspects of health and care in their own right, but the NHS cannot function without them. We also need to develop consensus on how the extra money should best be invested, and on how spending increases can be cemented into a sustained and recurrent funding solution, rather than delivering a short-term fix.

I believe that a cross-party commission would be hugely

beneficial in building consensus on these points – ultimately, I believe that we as politicians need to grasp the nettle and accept that the 21st century care our citizens deserve cannot be delivered without 21st century investment levels. What is needed is the political will to agree the fairest way of providing that long-term funding.

“Rising pressures are leading to a spiral of difficulties.”

“Welcome though extra funding for the NHS is, it is also essential to secure funding increases for public health and social care.”

Every day, millions of dedicated professionals working across a huge variety of disciplines within health and social care go

above and beyond to deliver the best care they can for those who depend on them. Yet descriptions of the difficulties facing health and social care are now becoming so commonplace that hard-pressed staff find that winter pressures extend year-round, with no respite.

Waiting lists are growing, and hospitals are running at full stretch, with bed occupancy levels at unsustainable levels. It is becoming harder to recruit and retain key professionals, and rising pressures are leading to a spiral of difficulties. Funding and workforce shortfalls are leaving a growing number of frail and vulnerable people with unmet care needs.

The art of the possibleA quick look at some of the topics the Health and Social Care Committee has covered over the past year bears out this impression of difficulties across the board. In our nursing workforce inquiry, we were told in unequivocal terms of a ‘crisis’ in nursing, with potential impact on safety. Our joint inquiry into social care funding found an equally pressing challenge there. During our childhood obesity inquiry, we heard that inequalities continue to widen, with the poorest

With the stakes higher than ever before, Dr Sarah Wollaston MP, chair of the Health and Social Care Select Committee, issues a rallying cry to politicians to unite behind a cross-party commission on health and social care.

Funding

Soapbox 25

Workforce

Green shoots along a long path

Despite huge strides to improve the recruitment and retention of NHS staff, there remains a long road ahead to tackle the workforce challenges facing health and social care in England, writes Danny Mortimer, chief executive of NHS Employers.

The NHS has faced a period of growth in demand for services, exacerbated by a decline in other public

services, especially social care. This trend has driven demand for additional staff from both the UK and international labour markets.

The last year has seen several positive developments in relation to the NHS workforce, but significant and immediate challenges remain and national support is vital.

Welcome developmentsThe NHS has welcomed the money being made available for the additional pay for all non-medical staff in England over the next three years. This will see marked improvements in starting salaries for all staff groups by 2021, following seven years of wage restraint.

This package was developed and agreed in partnership with all but one trade union and reinforces their vital role in representing and supporting our workforce.

Other positives include the reform of tier 2 migration rules, which will make it easier for the NHS to recruit doctors to work across the UK and will relieve pressure on work permits for other sectors of the economy.

The major national campaign to recruit the public to work as nurses and other healthcare professionals is another welcome move. We look forward to a similar and much-

needed campaign for our colleagues in social care.

And the Step into Health programme, supported by HRH The Duke of Cambridge and The Royal Foundation, is improving the employment of armed forces veterans in the NHS.

Work to doBut there are other areas where we still need national support to improve the supply and retention of the NHS workforce.

Greater flexibility is needed with the apprenticeship levy, to provide employers with more time to access funding and provide salary support to apprentices who are required to spend more than one day a week in formal education.

Restoring funding lost from national training budgets, known as CPD, to support the development and retention of our clinical staff, would also go a long way. As would additional funding for pay awards made to medical staff above the 1 per cent public sector pay cap.Furthermore, publication of the migration white paper would provide certainty for employers in both health and social care on access to international workers across a range of roles – including the care assistant workforce in social care – after the UK leaves the EU.

And finally, improved access to affordable accommodation and

transport for NHS workers in high cost areas, particularly in London, would make a notable difference to thousands of staff.

Local steps At the same time, employers in the NHS recognise there is more they need to do locally to improve staff – and thereby patient – experience.

This includes:• raising their profile as employersacross local communities, to attracta diverse range of employees• addressing the poorer experienceof black and minority ethnic (BME)employees• improving retention, focusingon new staff, career development,flexibility (which tends to mean‘predictability’ for our people) andmaking it easier to return to workafter retiring• enhancing the health andwellbeing of workplaces andimproving levels of attendance• appointing more women and BMEcolleagues to the most senior rolesto better reflect the workforce andcommunities we serve.

While the challenges facing employers are numerous and difficult, with the right approach and with some national support too, the outlook can be improved.

26 Soapbox

Five minutes with…Sharon Hodgson MPSharon Hodgson was appointed Shadow Minister for Public Health in October 2016. Two years on, we ask what the NHS means to her constituents in Washington and Sunderland West, and what Labour’s public health priorities would be should the party win the next general election.

What does the NHS mean to you?

After 70 years, our NHS remains one of the UK’s most cherished institutions. Rarely does an institution survive the tide of public opinion for so long. But it’s due to the hard-working individuals within the NHS, and the amazing things they do each and every day for all of us, that everyone values the NHS so much.

Like so many, I have experienced first-hand the world-class work our NHS does. That is why I will always campaign to protect it, to ensure that everyone has access to healthcare, free at the point of use.

Do people talk about the NHS on the doorstep? What do they say?

The NHS often comes up on the doorstep. My constituents are mostly concerned about funding for the NHS, the ever-growing pressures on the workforce and fears that this Conservative government is bringing in privatisation through the backdoor.

Many of my constituents already struggle to get an appointment with their GP – in some areas the wait can be over two weeks – and they’re concerned that the government could continue to make the matter worse.

I always make it clear that only a Labour government can begin to tackle these issues, and that I will always oppose any attempt by the Tory Party to privatise our NHS or move it away from its founding

principle of being free at the point of use for all.

If Labour won a general election tomorrow, what would be your first priorities for public health?

My long-term goal in government would be to make our children in the UK some of the healthiest in the world. That means a focus on children’s health from the day they’re born until they reach adulthood, and supporting families so that they can live healthy lives. That is why Labour will increase the number of health visitors and school nurses as part of a preventative healthcare drive.

Labour will also make it easier for families to make healthier lifestyle choices. I accept that there is no silver bullet to this issue, but in an attempt to make a difference, Labour will introduce a 9pm watershed on adverts for ‘high in fat, salt and sugar’ products and restrict the sale of energy drinks for under 16s.

When last in government, the Labour Party introduced free swimming for children and made it compulsory for schools to teach at least two hours of physical education each week. Both of these policies were scrapped by the coalition government in 2010. Just one in ten pre-school children currently meet recommended physical activity levels – that is why a Labour government would focus on getting our children fit and active once again to ensure they can grow up into healthy adults.

Improvements in life expectancy have stalled since the coalition government came into office in 2010. The inequality gap in healthy life expectancy at birth between the South East and the North East is 6.2 years for men and 6.8 years for women. Labour is determined to tackle these health inequalities, both across the country and within boroughs and local authorities.

Just as Labour is committed to ensuring children have the best possible start in life and grow up fit and healthy, Labour is committed to ensuring that older people are treated with the respect and dignity they deserve. That means building a new National Care Service, setting out funding alternatives to tackle the funding crisis in social care and providing care across the country that everyone deserves.

If you could pass on one message to future generations about NHS, what would it be?

Don’t take the NHS for granted. Millions of people up and down the country fight for its survival every single day, and that fight must continue so that generations to come can enjoy free and accessible healthcare, as generations gone by have.

We are very lucky to have such a world-class service, and it is up to all of us to make sure it survives in the future.

Interview

Soapbox 27

The upcoming NHS long-term plan and financial settlement are a real opportunity to recalibrate

the NHS budget. Statutory mental health services in England currently treat around 40 per cent of people with mental illness. While this is a significant increase from the one-in-three people we treated in 2007, it still leaves most people with mental ill health without treatment or support. This would be unacceptable in physical health.

Securing the future: Funding health and social care to the 2030s, commissioned by the NHS Confederation, states that a 3.4 per cent uplift in funding would only maintain the current level of service. Our members have been under enormous strain this summer – staying still cannot be an option.

The government must first guarantee significant funding to stabilise the system and then provide a solid foundation to improve and expand NHS-funded mental health services in England.

Sean Duggan, Chief Executive, Mental Health NetworkThe Mental Health Network is the voice for NHS-funded mental health and learning disability service providers in England.

NHS Clinical Commissioners is exploring five main changes to secondary legislation in the Health

and Social Care Act 2012 which would support implementing the integration and transformation

Moving the dial: How MPs and Peers can play their part

Making a difference

Three leaders from across the NHS Confederation discuss how politicians can make a difference to mental health, integration and waiting times in England.

agenda across health and care. These amendments will have a positive impact on the ability of health and care to deliver for patients.

• Responsibility to improvehealth and health outcomes – toensure that providers, as well ascommissioners, have responsibilityfor outcomes across a ‘place’and system, as well as their ownorganisation.

• Regulation and assurance – toensure there is a single processcovering all organisations.

• Payment reform – so the rulesreflect the move towards integrationand collaboration across NHSproviders within a ’place’. And toensure that both commissionersand providers agree on the financialrules.

• Accountability and governance– to be explicit about whereaccountability lies, for whichfunctions, and the expectationsaround governance across the‘place’ and ‘system’.

• Procurement, competition andchoice – for procurement to berequired only if the commissionercannot secure changes with theproviders within a ‘place’ andsystem; to introduce competitionand choice levers only if thecommissioner cannot securetransformative changes needed;and to give responsibility to the‘place’ and system to secure themandate for the circumstanceswithin which a patient’s choiceshould prevail.

We will be working with partners, politicians and our members to bring this to life to support the long-term sustainability of the NHS. If you would like to work with us on this, please get in touch at juliewood@nhscc.org

Julie Wood, Chief Executive, NHS Clinical Commissioners (NHSCC)NHSCC is the independent membership organisation for clinical commissioners in England.

NHS waiting times are currently at a decade high, with the number of people waiting more than the 18-

week target for routine operations – such as hip and knee replacements – now exceeding half a million.And the number of people waitingover 12 months for an operationincreasing by an astonishing 1200per cent in just five years.

It is therefore vital that the forthcoming ten-year plan for the NHS prioritises cutting waiting times. And lessons must be learned from previous governments’ experiences on this, notably making use of the significant spare capacity available in the independent sector. This avoids the need to build new NHS wards and hospitals, and allows NHS patients to better access high quality free-at-the-point-of-use care – all at the same cost to the taxpayer – as if provided in an NHS hospital.

David Hare, Chief Executive, NHS Partners NetworkNHS Partners Network is the representative body for independent sector healthcare providers.

The NHS Confederation at the Labour Party Conference – Monday 24 September 2018Does the Labour Party need another Nye Bevan moment to plug the funding gap in the NHS?

Time 10:00–11:00

Venue Albert Room 3, Hilton Liverpool

Chair Niall Dickson, Chief Excutive, NHS Confederation

Panel Jon Ashworth MP, Shadow Secretary of State for Health; Paul Johnson, Director, Institute for Fiscal Studies; Christina McAnea, Assistant General Secretary, UNISON; Mike Thompson, Chief Executive, Association of British Pharmaceutical Industry; Julie Wood, Chief Executive, NHS Clinical Commissioners

Developing the NHS workforce of the future

Time 12:00–13:00

Venue Pacific Room, Novotel Liverpool Centre

Chair Danny Mortimer, Chief Executive, NHS Employers

Panel Sheena Cumiskey, Chief Executive, Cheshire and Wirral Partnership NHS Foundation Trust; Dame Professor Donna Kinnair, Acting Chief Executive and General Secretary, Royal College of Nursing; Anita Charlesworth, Director of Research and Economics, Health Foundation; Dr Paul Williams MP and Member of the Health and Social Care Select Committee

What can local government do to improve mental health in local communities?

Time 15:00–16:00

Venue Pacific Room, Novotel Liverpool Centre

Chair Sean Duggan, Chief Executive, Mental Health Network

Panel Luciana Berger, MP for Liverpool Wavertree; Cllr Paulette Hamilton, Vice-Chair of the LGA Community Wellbeing Board; Joe Rafferty, Chief Executive, Mersey Care NHS Foundation Trust

The NHS Confederation at the Conservative Party Conference – Monday 1 October 2018What can local government do to improve mental health in local communities?

Time 11:00–12:00

Venue Lismore, Hilton Garden Inn

Chair Rebecca Cotton, Director of Mental Health Policy, Mental Health Network

Panel Rehman Chishti, MP for Gillingham and Rainham; Dr Julie Hankin, Medical Director, Nottinghamshire NHS Foundation Trust; Cllr James Jamieson, Leader of the LGA Conservative Group and Vice-Chair of the LGA;Andy Bell, Chief Executive, Centre for Mental Health

Developing the NHS workforce of the future

Time 13:00–14:00

Venue Lismore, Hilton Garden Inn

Chair Danny Mortimer, Chief Executive, NHS Employers

Panel Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care (invited); Anita Charlesworth, Director of Research and Economics, Health Foundation; Richard Kirby, Chief Executive, Birmingham Community Healthcare NHS Trust; Dame Professor Donna Kinnair, Acting Chief Executive and General Secretary, Royal College of Nursing

Does patient power exist? How to make the NHS more responsive to people’s needs

Time 14:30–15:30

Venue Jury’s Inn, Broad Street

Chair Jonathan Werran, Chief Executive, Localis

Panel Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care (invited); David Hare, Chief Executive, NHS Partners Network; Rachel Power, Chief Executive, The Patients Association; Stephen Dorrell, Chair, NHS Confederation

Can a Conservative government change the political narrative on funding for the NHS and social care?

Time 16:00–17:00

Venue The Gallery, Hilton Garden Inn

Chair Niall Dickson, Chief Executive, NHS Confederation

Panel Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care (invited); Dr Tania Mathias, former MP for Twickenham; Paul Johnson, Director, Institute for Fiscal Studies; Dr Graham Jackson, Co-Chair, NHS Clinical Commissioners; Mike Thompson, Chief Executive, Association of British Pharmaceutical Industry