The NHS 10 Year Plan – some great leaps forward, but there’s something obvious missing…
It may sound very Stalinist, but actually, a 10 year plan for the NHS is very welcome. It has gone through an enormous amount of change in the last ten years following the Lansley reforms and I’m guessing health care professionals might be looking forward to being able to do their jobs with some consistency rather than living under a permanent revolution (though is moving from Trotsky to Stalin a positive step?!).
There is a lot in the plan for older people to be pleased and hopeful about.
The first thing for me is the continuing emphasis that health and social care complement each other. Local Age UKs in London will see examples every day where, for example, helping with a welfare benefits check or arranging a befriender means that an older person is better able to look after their own health or deal with long-term conditions. Similarly, early and appropriate treatment of medical can mean that older people are more able to enjoy their lives and be part of their community.
Prevention is key theme of the Plan, although it focuses specifically on 5 areas – smoking, obesity, alcohol, air pollution and anti-microbial resistance. But even this is a huge step forward in challenging the “treatment” model that the NHS is built on – dealing with what the patient presents as a problem. It also talks about individuals playing their part in achieving health outcomes, which is also welcome. The NHS needs to work “with” patients not “on” them.
The emphasis on care in the home is good news – the last thing older people need is to be in and out of hospital, with all the physical and emotional upset that causes. Obviously there are conditions and procedures that will need hospital admission, but the idea that the NHS should actively work to keep people away from hospital and receive care in a more appropriate setting is another cultural shift that will benefit older people.
The Plan outlines how some of this will be achieved, mostly through the better use of technology. The technology for (for example) online consultations with GPs has been around for some time – now it can be put to good use. The issue for older people here is not their capacity to engage with technology – in general if it is introduced in the right way with good support, older people are more than happy to use technology. Where it becomes an issue is where older people cannot access the internet due to poverty or other circumstances, and where their conditions mean that learning something new is way down their list of importance.
These are three areas of the Plan I think mark out this as not just a gimmick, but something meaningful in the history of the NHS.
Other commentators have talked about the Plan being unrealistic as it need more funding or more staff – my problem is that it fails to join up health and social care on anything more than a token level.
The reality is that local authorities and clinical commissioning groups continue to struggle with the relationship they share on health and social care – in some areas they are working well together, in others they are barely talking. This is also reflected in the solutions, for example social prescribing, that are coming out to meet local need, which seem to be different in every area. True, they might be reflecting local need, but if every local authority and CCG are coming up with their own systems and solutions, then the duplication and extra cost is phenomenal. What is needed is leadership on this from above.
The key problem is that whilst it is now called the Department for Health and Social Care, large parts of social care are actually delivered through local authorities – for example, personal care, safeguarding, day to day living support, maintaining independence. The power to deliver these services is devolved to local authorities, who have struggled with growing need, rising costs and reduced funding. The valuable interventions I talked about earlier (welfare benefits checks, befriending) come under this funding, not the NHS 10 Year Plan.
We’ve also been waiting for the social Care green paper for over a year, and this represents the missing piece of the jigsaw – how to address these social care needs in a way that improves the wellbeing of older people, and is sustainable. It would have made more sense launch to two together, and make the whole system properly joined up. I hope that when we get the green paper it won’t mean a re-write of the NHS 10 Year Plan…
So whilst there are some very welcome polices in the NHS 10 Year Plan, it is only half of the story on improving the wellbeing of older people, and without the Social Care green paper it could well be seen a missed opportunity.