There can seem to be a lot of political argument about health and care policy, but really there’s a lot of agreement about what the challenges are, and how to meet them.
Below is an overview of the key issues, compiled by The Patients Association, with our recommendations for what the key priorities should be after the election.
Health and social care must be adequately funded
Health and social care are not funded in a straightforward way. The NHS is a national service, funded by tax and free at the point of use. However, social care is provided by local authorities, is means-tested and can be charged for.
It is widely acknowledged that the health and social care system is struggling to operate on its current funding levels. The National Audit Office has found that, “[the NHS’s] financial problems are endemic and this is not sustainable.”
The NAO also found a relationship between hospital trusts’ financial and clinical performances: worse finances correlate with lower Care Quality Commission ratings.
A course must be set, at some point, towards a sustainable long-term settlement for health and social care. This will require spending a greater proportion of GDP, and therefore almost certainly raising more funds from taxation. The independent Barker Commission, for instance, has identified ways of achieving this. Before that, the Dilnot Commission identified a possible way to make social care funding fairer.
The consequences of a lack of proper long-term funding would be serious. Treatments would have to be rationed, with increasing variation from place to place. Patients would face longer waiting times, and we could see growing numbers of people dying while on waiting lists. The NHS’s culture of compassion and safety would also be put at serious risk. The quality of life available to people with social care needs would fall further.
Health and social care must be transformed to meet people’s needs
Our health and care system was originally designed to deal with periods of illness, possibly including a period in hospital, after which either the person returned to health or nothing more could be done for them. Now, many conditions are survivable and treatable over the long term, and as we live longer we are more likely to develop and live with long-term conditions. The NHS was not designed to deal with this pattern of ill health.
NHS England’s Five Year Forward View is a plan to redesign the NHS to address this changed pattern of need. No other serious alternative way of doing this has been put forward. NHS England needs to engage better with patients and communities – but provided it does that, its Five Year Forward View should be supported and delivered.
Sustainability and Transformation Partnerships are the NHS’s local bodies to deliver this change. They are implementing Sustainability and Transformation Plans. Some of these plans have been controversial. However, knee-jerk responses to STPs, for instance to defend local hospital services, even if they are outdated and inconvenient, are probably not helpful. But STPs must engage properly with communities to explain the case for changes.
There is also sometimes comment about ‘privatisation’ in the NHS. As we’ve seen, the changes we need are about redesigning services to meet patients’ needs as the population ages. Concerns about ‘privatisation’ are probably a bit of a red herring. The NHS has always relied heavily on private contractors such as GPs and high street pharmacists – of itself, private sector involvement needn’t be a problem, as long as the system remains adequately funded and accessible to all.
Health and social care must be person-centred
To be effective, care must take full account of each person’s needs and preferences, and be planned and co-ordinated in line with their wishes. It should allow them to live as well and as independently as possible, and support their carer/s and loved ones who support them.
This approach needs to be followed not only at an individual level, but across the whole health and social care system. Fully engaging individuals in their health, care and wellbeing, and fully engaging communities and the voluntary sector, should be part of normal business.
Person-centred care cannot be achieved if some categories of care are accorded lower priority than others – automatically, anyone in those categories will not get the care they deserve. Accordingly, parity of esteem for mental health is vitally important.
Carers are essential to the wellbeing of many people with health and care needs. Their contribution is estimated to be worth £132 billion per annum in economic terms. In turn, they too must be supported by the health and social care system.
Integration between different parts of the NHS, and between health and social care, is also essential. There should not be barriers between services that make it difficult for people to get the support they need.
Health and social care must be safe and compassionate
Most people have good experiences of the NHS, but when things go wrong it is vital that there are strong systems for raising concerns and making complaints. There is plenty of room for improvement in this regard.
When care goes wrong, it can go very badly wrong indeed. The Patients Association’s Helpline hears from people not only when there have been failures in safety, but also when the system has failed to be compassionate, inclusive and accessible.
The health and social care workforce must be sufficiently large, well trained, well supported and structured correctly to meet patients’ needs. Without this, safe and compassionate care will not be delivered.
Both the NHS and social care services must be better at acknowledging error and learning from mistakes for the benefit of future patients. The system must be accountable and transparency in it must thrive. Patients, carers and staff must all be empowered to raise concerns. Complaints mechanisms and the Parliamentary and Health Services Ombudsman need to be improved.
There are links between safety, compassion and funding. Financial pressures and unsafe staffing levels were factors in the collapse of quality and safety at Mid Staffordshire Foundation Trust. Pressure on hospital beds also appears to jeopardise safety, by increasing the risk of hospital-acquired infections once occupancy rates rise above 85-90%
Brexit must be made to work for health and social care
Brexit creates both challenges and opportunities for health and social care. It is vitally important that these are both navigated successfully.
The health and social care workforce contains substantial numbers of people from overseas. Over 57,000 NHS workers are EU nationals from outside the UK, and over 71,000 more come from outside the EU. As immigration rules change, it’s vital that we maintain the workforce we need, whether from new patterns of international recruitment or, in the longer term, from increased training within the UK.
Leaving the EU will also have implications for how we regulate medicines and treatments. We may no longer be part of the EU-wide market for pharmaceuticals, which accounts for 25% of global sales; the UK on its own accounts for 3%. In Australia and Canada, where medicines are licensed nationally, typically patients access new medicines 6-12 months later on average than those in the EU – patients in the UK must not be subject to the same delays.
Medical research to develop new treatments currently attracts a lot of EU funding into the UK. EU grants awarded to researchers before Brexit are being underwritten, but will the full value of EU funding be replaced for future projects after we leave?