The review of the NHS led by Lord Ara Darzi paints a clear picture of a health system in critical condition. And if it’s the proverbial wake-up call, we know the alarm hasn’t just been ringing for many years, it’s been growing increasingly louder.
Indeed, the report reflects and acknowledges what many working in the NHS have known for some time now. The system must fundamentally change to create a better experience for both patients and staff.
They say the first step on the road to recovery is honesty. In that regard, the Darzi Review should be applauded for taking an unflinching look at some hard truths. Years of underinvestment, a shrinking workforce and growing demand have seen public satisfaction hit its lowest. While at the same time, prevalence of long-term conditions and ill health have grown and health inequalities have widened.
And yet, despite all this, across the system, teams have continued to work tirelessly to serve the needs of patients. There is some truly amazing care being delivered at all levels despite current challenges.
In primary care and community services in particular, teams have somehow found a way to do more with increasingly less. While with some irony, the report conversely acknowledges that investment in these very sectors has consistently demonstrated a superior return on investment.
Plans for the ‘biggest reimagining’ of the NHS since in its exception are certainly warranted. In terms of what that might mean, let’s take a closer look.
We know that when primary care has resources and is empowered work to the topic of its license it not only improves health outcomes but releases pressure across the system.
As the first port of call for patients, primary care needs more support, concrete solutions to workforce gaps and real investment. In the last decade, relative share of NHS expenditure in primary care fell by a quarter, and reversing the balance has rightly been identified as the fundamental strategic shift required.
While we wait to see how this will be formally implemented, reinstating primary care as the ‘jewel in the crown’ of the NHS is a much needed move in the right direction, and if fully actioned, could be a true difference maker.
Alongside this, we can also expect a renewed focus on how to shift care further upstream, with hospitals reserved for specialist care.
This could take the form of co-location of services some commentators have predicted – whereby GP services sit alongside other providers in ‘neighbourhood hubs’ without taking the form of a large-scale poly clinic. Some organisations are already operating similar models already.
It’s clear that multidisciplinary working is here to stay and it makes perfect sense. The ability to provide more holistic models of care can unlock efficiency gains and improve patient experience with a range of services located ‘under one roof.’ From specialist pharmacy through to physio and mental health services.
Our growing, ageing patient population has been identified as the most significant driver of increased health needs.
Certainly, we are seeing increasing complexity, with analysis indicating 40% of people aged 65-74 having two or more long-term conditions. This figure rises to 60% in those aged 75-84. While prevalence of hypertension, CVD and diabetes are also on the rise.
In response, we expect to see the system continue to double-down on chronic conditions and preventative programmes that reduce health inequalities, from ICB level all the way down to local authorities.
In terms of possible formats this could take, most notably the NHS Diabetes Prevention Programme is highlighted within the report’s pages. Reducing risk of diabetes by nearly 40%, the programme offers evidence-based lifestyle education and is available both face-to-face and through digital platforms, combining peer support with tools and technology.
Certainly here at Suvera, we’ve seen first hand the benefit such models can have with our virtual group consultation service, which has both reduced risk factors such as obesity and the daily burden of living with diabetes.
Accompanying the shift from treatment to prevention will be a ‘tilt’ from analogue to digital. While other sectors have accelerated use of technology, the NHS has largely not kept pace with some parts ‘yet to enter the digital era’ to quote the report.
This in itself is identified as a key factor as to why the system has not wholly shifted from historical ‘diagnose and treat’ models of care to preventive and predictive ones.
In response, care providers outside of hospitals will be given the support to adopt digital systems and AI tools that unlock productivity and efficiency gains.
Although the review does highlight how some GP practices have embraced ‘extraordinary innovations’ in adopting digital models that have improved access, care quality and triage.
Finally, while the report predominantly lays out problems and paints a stark picture of a system ‘in trouble’, it is also one whose vital signs are said to ‘remain strong’.
Why? Because of staff and the ‘extraordinary depth of clinical talent’ that resides within the NHS, who are committed to making it better for patients. Rightly referred to as its beating heart, this gives much reason for hope.
Primary, secondary and community care services should all be applauded for their continued, unwavering resilience in the face of unrelenting demand, having worked through a pandemic no less.
Now, as acknowledged within the report, there is a need to ‘re-engage staff’ to make positive change and rebuild faith and morale. Doing so can help ensure the long-term sustainability of the health system, and a better experience for both patients and staff.
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