A new independent report has highlighted the importance of preventative and personalised care that is delivered closer to home.
The document – published by an independent advisory group to the NHS called the NHS Assembly last week – said that this, alongside investment into general practice, would help deliver better outcomes for patients and save the health service money and should be a key focus.
In addition, it suggested setting out what patients should expect from the NHS, and how they should participate in managing their own health and using services wisely.
The report outlined five ways to shift to co-ordinated care closer to home, including:
- Strengthening primary care and community services in every neighbourhood in the country
- Fully implementing the Fuller stocktake report – which recommended a more active role for community pharmacy; integrating better with local government services, especially social care; and building community hubs.
- Breaking down divisions between primary, community and acute care and enabling specialists and GPs to work together more effectively
- Accelerating the growth of hospital at home services and virtual wards
- Valuing the work of volunteers
But it said that staff needed to be supported to make this happen.
In particular, it said that staff needed to be rewarded fairly, with ‘equal opportunities to learn and gain promotion’, and that their voice needed to be heard.
They should also be able to ‘work flexibly in an inclusive, safe and healthy environment while supporting each other’, the report said.
The report – which has been published ahead of the 75th birthday of the NHS – added that the public should ‘be supported to play an active role in their health and wellbeing and care’, rather than being ‘passive recipients of care’.
It said that societal change outside of the NHS’ remit would need to take place to prevent ill health, noting that 80% of health outcomes are determined by external factors such as income, housing education and employment.
And while the report recognised that people’s behaviours are ‘influenced by the environment in which they live and work and the resources at their disposal’, it said that patients and health professionals should be seen as ‘partners in the therapeutic relationship’, thereby avoiding over dependence on health and care professionals.
Those behind the report also proposed an agreement with the general public to set out ‘what people can expect and what they can contribute’. The report added that this ‘reciprocity’ remained ‘vital to the NHS and its future’.
It said that patients should promise to treat staff with respect, ‘to use services wisely and recognise the contribution they can make to care delivery in partnership with staff’.
And it added that people need to be willing to adapt their own engagement with the health service as it changes and recognise that ‘there are limits to what can be offered’.
It suggested that Integrated Care Systems (ICSs) were well placed to engage the populations they serve on such an agreement.
The report also highlighted the need to invest in buildings and infrastructure, with a focus on facilitating the shift of care closer to home, as well as ensuring the NHS has the capacity to respond to shocks, such as a new pandemic.
One comment quoted in the report from engagement with the NHS Assembly’s stakeholders said that while ‘a significant amount of work is to be done to strengthen primary care’, the NHS was ‘lucky to have outstanding primary care, especially pharmacy services with great accessibility’.
And it said that ‘greater value hinges on investing in general practice, delivering more care closer to home, and intervening early to prevent the onset of ill health’.
‘By providing more care in lower cost settings, the NHS will be able to deliver better outcomes with the resources at its disposal,’ the report said.
Meanwhile, the NHS must also ‘go further faster’ in taking advantage of advances in digital and data, it suggested.
In particular, it highlighted the opportunity of creating a fully connected electronic patient record across hospital, primary and community care, with key elements visible to social care. In addition, it noted the need for more widespread use of the NHS App to enable patients to access their medical records and services.
But report authors acknowledged that ‘investment is needed in information systems to help identify and respond to need, as well as to ensure interoperability between different systems’.
The NHS Assembly also said that local partnerships needed to be strengthened, highlighting ICSs as a body with a ‘key role’ to play in doing so.
‘As statutory bodies, ICSs bring NHS organisations, local authorities and other local partners together to plan and deliver joined up health and care services to improve the lives of people in their area,’ the report said.
While ICSs will ‘need time to mature’, the NHS Assembly said that there were ‘already good examples of progress in changing pathways; building partnerships with the [voluntary, Community and Social Enterprise] sector and patients and carers; sharing budgets; creating single teams; and collaborating with leading digital innovators’.
‘Getting the basics right by supporting operational and clinical leaders to put in place and sustain established best practices in service delivery is essential’, the report added.
The NHS Assembly advises the board of NHS England on the delivery of the NHS Long Term Plan and consists of individuals across the health and care sectors, including pharmacist Ravi Sharma, head of pharmacy at Luton and Dunstable Hospital and deputy chief pharmacist and deputy clinical director for medicines optimisation at Bedfordshire Hospitals NHS Foundation Trust.
NHS chief executive Amanda Pritchard said that she was ‘hugely grateful to the NHS Assembly for this important piece of work’ ahead of the health service’s 75th anniversary.
‘After some of the most challenging years in NHS history, I know how energising many colleagues have found having the chance to think about opportunities to improve health and care for the future.
‘And by taking into account such a wide range of views from our patients, staff and partners, this report will help to build on the progress already made, both locally and nationally, for years to come,’ she said.
The chief executive of NHS Providers, and NHS Assembly member, Sir Julian Hartley commented that as well as tackling health inequalities and delivering care closer to home, ‘we heard from patients and the public that investment in staff and capital, alongside social care reform, is vital to give this and future generations safe, high-quality services’.
And Rachel Power, chief executive of the Patients Association and NHS Assembly member said that it was ‘absolutely right the NHS should deliver care tailored to meet the needs of different communities and that services should be based on the insights and priorities people have for their own care’.
But she added that ‘to achieve this across England will require changes in culture and practice across the NHS.
‘This will take strong leadership to deliver a learning and improvement culture that can foster the creation of an NHS that works in partnership with those it serves,’ she said.