To have any value, discussions about future plans for the NHS must reflect the reality of the ‘most significant pressures in its history’ resulting from Covid-19 and now inflation and the cost of living crisis, according to the NHS Confederation in a new report.

The organisation that brings together, supports and speaks for the healthcare system in England, Wales and Northern Ireland says the NHS needs an honest vision for what it should seek to achieve over the remainder of the decade, and how it will be supported to do so amid the severe pressures local services are experiencing. 

A renewed vision for the NHS argues that any review of a long-term strategy should seek to achieve three objectives: to present a less centralised approach, offer clarity for how systems can act as bridges to a bolder and more optimistic future and be honest about expectations and acknowledge the need to get the public onside in navigating the capacity challenges the service is facing. 

Fewer, more focused, targets are needed for a less centralised approach reflecting a different health and care landscape, the Confed says. “Retained national targets should focus on the five clinical target areas laid out in the CORE20PLUS5 approach (maternity, severe mental illness, chronic respiratory disease, cancer and hypertension), where national intervention has been effective. New targets would be unwelcome without additional funding and resources.”

National action is needed to improve dentistry before integrated care systems (ICSs) take on formal commissioning powers, while local leaders should be allowed to lead elsewhere. “We need to see a sustained shift towards empowering local integrated care systems to focus on the things that matter most to their local communities.”

To enable systems to deliver better outcomes for their populations, planning should be backed with a comprehensive and funded workforce strategy that addresses the profound challenges in social care as well as health, the organisation suggests.

To help, there should be a 10-year moratorium on any further imposed structural reform of ICSs, while tackling health inequalities and digital transformation should be the ‘golden threads’ that run through the system. 

To set out a realistic optimism about what the NHS can achieve by 2029, a long-term strategy should address funding, but be realistic about where greater investment will be required. “The strategy should make clear from the outset that the NHS is experiencing a real-terms funding cut due to soaring inflation and other cost pressures. Political leaders will need to level with the public about the financial constraints the NHS is operating under and therefore how long it will take to improve performance on waiting times.” 

That strategy should include a narrative that the NHS is an ‘investable proposition’ and that it is critical for wider economic and social development. As part of that development, the Confed says there needs to be ‘close and meaningful engagement’ with the public on self-management and personalisation. “The strategy should outline an aim to ensure individuals can be treated at home or in the community through new innovations. The public will need to be supported to play a more active role in their own care through shared decision-making.”  

Step closer to interoperability

Shared care records across primary care have moved on a step with the publication of a new Professional Records Standards Board (PRSB) report that extends the use of its standard for people’s shared care records to professionals working in pharmacy, optometry, dentistry, ambulance and community (PODAC) services.

The PRSB says its Core Information Standard for shared care records will ensure that professionals working in these care settings, subject to appropriate controls, have access to the right information at the right time to provide clinically safe and effective care. 

“The GP record could be used to accelerate sharing of care data with professionals working in these care settings, as much of the information identified by the Core Information Standard is already available in current GP systems and can be shared widely,” the PRSB says. “Using the standard in these settings should improve care and outcomes for people and it should improve the working lives of professionals, who won’t need to create workarounds to ensure they have a complete picture of a person’s current and relevant care history before starting treatment.”

James Palmer, programme head for digital PODAC at NHS Digital, said: “Better access to relevant information means the clinicians treating us have a more complete picture of our health and can make more informed decisions about our care – ultimately supporting better outcomes for patients and a better experience all round.”

The report follows in-depth evidence gathering and robust consultation, including via online workshops with multidisciplinary professionals, service users and suppliers, to test whether the core information standard would provide the information required for care, or whether additional information or even new standards were needed. The Royal Pharmaceutical Society was a key stakeholder in the project.

The move comes as a new survey from the Community Pharmacy IT Group reveals significant gaps in the current state of pharmacy IT provision. Over half of pharmacies in England reported at least one IT shutdown each month, while more than 40 per cent said they have a poor mobile phone signal and limited internet connectivity. An overwhelming majority – 83 per cent – favour a move to paperless working, but many pharmacy teams lack digital resources. 

Sixty-eight per cent said their pharmacy had no tablet-sized mobile devices, 24 per cent said they had one and three per cent said two, while 50 per cent said they did not have a laptop. Over 63 per cent said there were no pharmacy-owned smartphones in their pharmacy on a typical day.

Diagnostics pivotal, but system failing

Government restrictions on the building of new facilities and the limited range of tests on offer at new community diagnostic centres risk limiting their potential to increase capacity and provide quicker and more convenient access for patients, according to a new report from The King’s Fund. 

In Why do diagnostics matter? the charity says diagnostics have a pivotal role in supporting system recovery from the pandemic, including reducing waiting times for hospital treatment and earlier cancer diagnosis. A concerted policy focus and an increase in workforce and capital investment are required if the much needed increase in diagnostic capacity in the NHS is to be realised. 

Each year, the NHS undertakes more than one billion diagnostic tests, accounting for about six per cent of the NHS budget. Demand is rising, with four to seven per cent increases in activity seen for tests such as colonoscopies and magnetic resonance imaging (MRI) scans each year between 2014/15 and 2018/19.  

At the same time, growth in the diagnostic workforce has not kept pace with demand and activity, and there are now significant staff shortages across all specialties, with imaging, radiology, pathology and endoscopy notably under strain. Similarly, “historical underinvestment means that the supply of equipment such as computerised tomography (CT) scanners, MRI units and X-ray machines is inadequate and existing equipment is often outdated and in need of replacement.”

More than 1.5 million people are currently waiting for tests; the standard that patients should wait less than six weeks for a test has not been met since February 2017.