We wrote some 5,000 words on what should be included in the 10-Year Health Plan in the consultation and the biggest challenges and enablers around getting more care moved into the community, embracing digital and technology, and spotting illnesses and diseases earlier. Here are a few key points.
1. This plan needs to be bold. This means it needs to deliver measures and approaches which reduce fragmentation and which tackle issues system-wide.
Small scale schemes and pilots with short-term funding solutions are not sustainable. We need a far-reaching plan that will improve health and sustainability in the medium and long term while simultaneously addressing more immediate and pressing issues.
It also needs to reassure and build trust. Disjointed systems and a lack of community-based staff and buildings create barriers. We know some residents, and staff, are worried about the future, so it needs to address those concerns.
2. We need significant investment in capital and digital infrastructure. The current limited capital allocation system results in sub-optimal allocation of scarce investment.
Many buildings across primary and secondary care are not fit for purpose. Maintenance and refurbishment costs of the current physical estate are significant. A new, realistic assessment of the investment and timeframe needed to deliver improvement is needed, and a new minimum of five-year capital planning allocations should be the standard. We gathered evidence that demonstrated higher levels of emergency attendance from practices with lower quality estate, lower numbers of salaried GPs and lower levels of GP training. In the last two years, we have invested 5% of our capital allocation directly to addressing the quality of the primary care estate.
Local care estate must be a priority and there is a need to rapidly increase the share of capital going to GP and wider community-based estate. We need IT infrastructure that supports this transition and we must ensure support is available to staff in those settings.
3. High quality, easily accessible primary care is key to prevention, early treatment, improved quality of life and reduced pressure on the NHS. Yet only 9% of national spend is allocated to primary care despite the growth in list sizes and demand. Despite increasing numbers of appointments being offered, patients still report issues with access. We need to support general practice and ensure it remains attractive.
Ensuring high quality provision as we move care out of hospitals will require increased funding to primary care, before secondary care spending can be reduced, as benefits will take time to realise.
This includes tackling the all-too-common interface issues between primary and secondary care. The gaps in care created by the poor interface are a patient safety issue. They impact our ability to move care closer to home and intervene early. This is exacerbated by IT that impedes data sharing and consistent recording.
We would welcome more specific national requirements on system partners to ensure smooth inter-organisational interfaces. Financial levers that incentivise more effective collaborations and create clearer accountability would increase efficiency, reduce risk and provide better patient experience.
4. There are undoubtedly differences of opinion about the right models, which will vary depending on individual circumstances.
But if we are really going to shift the dial, there needs to be better alignment and integration at a more localised level – at place, or even more locally at neighbourhood level. This is not new, particularly within local government. But it can be the best level to really target specific population groups, population health challenges, or change specific services.
Proactive, multi-disciplinary working should be the default, particularly for ‘high risk and complex' population cohorts. Physical and mental health and well-being must be assessed and addressed together. Resources should be pooled, integrated and increased. Staff must be enabled to spend a greater proportion of time on proactive care and operational integration with access to multi-disciplinary support at neighbourhood level, as they would in a hospital. Job descriptions, terms and conditions need to reflect these ways of working.
In October 2024, Camden launched its first Integrated Neighbourhood Team, bringing together staff from Central North West London Trust and the council to support adults with health and care needs. Working from a shared office, health, social care, mental health services and voluntary sector professionals work as one team, simplifying access for residents and making life easier for individual teams. While it is still early, the reports are positive. It will be fascinating to see how this develops.
