Highland Marketing Advisory Board Responds to the NHS Long Term Plan

Highland Marketing Advisory Board Responds to the NHS Long Term Plan

The NHS Long Term Plan was published at the start of January. The 134-page document sets down how the health service in England will spend the £20.5 billion a year “birthday present” that the government unwrapped for its 70th anniversary last July.

Alongside headline-grabbing initiatives on mental health and primary and community care, the plan lays out an ambitious agenda to return hospitals to financial balance, while progressing the Five Year Forward View’s vision of population-level planning and funding, aligned with more integrated health and social care.

The plan says accountable care organisations – now called ‘integrated care services’ – will be rolled out across England by 2021, while a new ‘service model’ is developed to give individuals more ‘differentiated’ options for treatment, support and advice.

Almost every element of the plan depends on IT and technology gets its own chapter to outline proposals to complete the deployment of electronic patient records in hospitals, develop a new model for integrated care records, abstract and use data, and enable individuals to interact with the NHS through personal health records and apps.

A week after the launch at Alder Hey Hospital in Liverpool, Highland Marketing’s advisory board met to discuss the plan and what will need to happen to make it a success. “Was this,” asked chair Jeremy Nettle, “the birthday present that the NHS wanted?”

Great, but what about implementation?

The consensus was that it probably was, although there is a lot in the plan that is familiar, and implementation will be critical. “It is encouraging, because it is more substantive than the Five Year Forward View, and it is proposing to invest in technology,” said James Norman, healthcare CIO, EMEA, DellEMC. “The question is how to do it.”

The ideas in the Forward View were supposed to be taken forward by 44 sustainability and transformation partnerships. But most have made only limited progress and just 14 areas of the country are “working towards” ICS status at the moment.

Meanwhile, acute deficits have hit £1 billion a year, and NHS performance against key targets has slipped. The advisory board argued that to make progress this time, board-level leadership will be vital. Also, that where it’s missing – or distracted by deficits and day to day pressures – the centre will need new levers to pull.

NHS England is already using the NHS operating framework and financial regime to move towards joint control totals for commissioners and trusts and to push CCGs to merge. But the plan lays out legislative proposals to undo some of the structural and competitive elements of Andrew Lansley’s 2012 reforms; and the advisory board felt these would be needed.

“It is hard to believe ICSs will not happen, because NHS England has said so hard that they will happen,” said Andy Kinnear, the director of digital transformation at NHS South Central and West Commissioning Support Unit. “But this is a hard agenda, and it will need legislative change.”

However it is achieved, the board felt that consolidation on a 1/7/44 model (a merged NHS England/ NHS Improvement, working through seven regions announced just before Christmas, and mapped to 44 STP/ICS footprints) is the right way to go.

Jeremy Nettle, a health tech industry veteran who started his career in the NHS, argued the NHSE/I regions are already “looking a lot like the old regional health authorities” and that this was a good thing, because they had the coherence and authority to drive change in their patches.

Andy Kinnear agreed. “I am missing the old strategic health authorities,” he said. “I never thought I would say that, but it is true.”

Tech needs leadership and investment

The board felt similar issues would apply to the technology agenda set out in chapter five. Andy Kinnear said board level leadership would be particularly important for IT and welcomed its call for a chief information officer or chief clinical information officer to be on every board.

He warned, though, that these new CIO and CCIOs would need appropriate skills and training. Money will be required. Both Andy Kinnear and James Norman noted that a lot of money has gone into NHS IT over the past decade and a half.

The National Programme for IT in the NHS had £17.4 billion to spend on national infrastructure, services, and contracts to roll-out EPRs, while former health secretary Jeremy Hunt launched tech funds for ‘paperless’ initiatives, such as e-prescribing.

However, NPfIT mostly failed, and tech fund money was diverted to other uses. So, the board argued, while money is undoubtedly needed, it will need to be spent wisely and its impact will need to be monitored. Also, it will need to be spent at the right level.

Read the full article at thejournalofmhealth.com