Healthcare in the 2020s

The NHS long term plan published in January 2019 set out a vision for major change and restructuring over the course of the current decade. It describes how the health service in England is moving to a new service model with six key principles:

1. Care and support are personalised, person-centred, co-ordinated and empowering
2. Services are created in conjunction with people and their communities
3. Focus is on equality and narrowing health inequalities
4. Carers are identified, supported and involved
5. Voluntary, community, social enterprise and housing sectors are key partners and enablers 
6. Volunteering and social action are key enablers.

A major element hinges on the creation of Integrated Care Systems (ICSs), described by NHSE as “partnerships of organisations that come together to plan and deliver joined-up health and care services, and to improve the lives of people who live and work in their area”. 

The 42 ICS regions were established as legal entities last June. Each has an Integrated Care Board (ICB), which is responsible for planning and commissioning health services based on local need. 

The key purposes of ICSs include improving population health and healthcare; tackling unequal outcomes and access; enhancing productivity and value for money, and helping the NHS to support broader social and economic development. The aims of preventative activity in an ICS are as follows: 

1. To improve the health, wellbeing and healthy life expectancy of our population, reducing inequalities in outcomes, experience and access where they exist
2. To promote independence, enabling those with long term conditions and other needs to exercise choice and control over their care, including options for improved self management
3. To coordinate and maximise effective action across settings and sectors, particularly increasing the preventative impact delivered through healthcare services, so that residents can access coherent support wherever they interact with health and care services
4. To enable staff to work in different ways – promoting wellness, social connection and self-management
5. To enhance broader social and economic development, in line with the Robert Wood Johnson model of wider determinants of health
6. To steward shared resources effectively, seeking to achieve the greatest sustainable value for our population.

As the above list shows, the move towards more local integration provides a number of opportunities for health providers to make interventions that encourage patients to be in the driving seat when it comes to their own health and wellness. One of the flagship policies aimed at facilitating this is social prescribing. 

This is a key element of improving population health and a way of GPs and other healthcare professionals referring people to activities or services in their community instead of offering only medical solutions.

The aim is that by 2023/24, more than 900,000 people will benefit from social prescribing, a personal health budget and new support for managing their own health in partnership with patient groups and the voluntary sector. Social prescribing schemes can involve a variety of activities that are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, gardening, befriending, healthy eating advice and sport.

Social prescribing can work for a wide range of people:

• With long-term conditions
• With mental health needs
• With complex social needs
• Who have a desire to lose weight and get fit
• Who are lonely and isolated
• Who are in need of help with housing, financial or employment issues.