In 2020 and beyond we must embrace the tenets of population health - with all that that entails | Niall Dickson

Niall Dickson

There was a time when the NHS went into a form of hibernation over Christmas. Wards were emptied and staff took time off.
The contrast with modern reality could hardly be more stark.
We should not look back through a rose-tinted lens at a time when healthcare was much less safe and much less effective, but it is striking that in many ways public and political perception has not moved on.
This is seen most obviously in the currency of the NHS being seen solely about the numbers of doctors, nurses and hospitals.
All, of course, are critical but the meaningless figures of more this and more that disguises the scale and the complexity of the challenge we face.

2019 was a year of significant policy development in England – the launch of the Long Term Plan, with its large number of significant commitments, the creation of Primary Care Networks, the ambition to create Integrated Care Systems throughout the country by April 2021, the development of local plans, and alongside this at least some signs that the government recognises the need to invest in capital, social care, public health and training.

But how much of this has touched the reality of staff managing trolleys in Emergency Departments, far less patients and their families?
By any standards the next few years are going to be difficult – the service you run is regarded by many politicians as having done well in the latest financial settlements and for all the hype and rhetoric, there is little sign of any real understanding of what the service faces, not just in government but across the political spectrum.
Yet if we are to break through, we will first need (even) more investment.
When all the glossy wrappings are removed, the reality is, the NHS needs four per cent real terms growth every year for the next ten to fifteen years and social care much the same if they are to have a good chance of bringing about the change that is required.
That was the conclusion of the report we commissioned from the Institute for Fiscal Studies and the Health Foundation to help secure the extra funding in the first place, and its arguments remain valid today.
Depending on how you calculate the extra funding, we currently have around 3.4 per cent which means the job of radical reform is extremely challenging.
And at the same we will also need political cover.
Change is not just about setting out bold aspirations, it involves training new staff, developing new roles, creating new services, adopting new ways of working, launching entirely new models of care, adopting new technology, driving through reconfigurations which have long been resisted and changing the relationship between patients and the health service they love.
It means every part of the service adopting the tenets of population health, with all that that entails, while continuing to provide a great service for the acutely ill.
Yet, thus far we have all presented this as a series of transactional and iterative changes. Rather it is or should be a social movement which requires everyone to look at the world differently, and that will mean winning the hearts and minds of NHS staff, politicians, communities, families and individuals and redescribing what it is we are seeking to achieve. Because this new narrative is much more radical and much more difficult than has thus far been acknowledged.
And perhaps the greatest danger of not engaging is that the politicians and perhaps the public will run out of patience.
Together we must work to convince them locally and nationally that though the journey will be difficult, we have no alternative but to embark upon it if we are to create a sustainable future for this service we love.
Finally, here is a link to some of what we at the Confederation have been up to in the past year. I hope it gives you a flavour of what we have been trying to achieve – as ever though please do let me know if you have any comments or suggestions as we head toward what can only be described as ‘interesting times’!

Niall Dickson is chief executive of the NHS Confederation. Follow him on Twitter @NHSC_Niall.

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