In part two of his two part series on the NHS, Charlie Winstanley explores policy recommendations that can transform our healthcare system to be a person-centred and digitally-enabled NHS.
In part one of this series, we explored the implications of the Healthcare Infrastructure Plan (HIP), published by the incumbent government in late 2019. I argued an investment in hospital vanity projects will serve simply to exasperate the issues with our current health and care system, as well as further entrench organisational fiefdoms. The COVID-19 pandemic provides an opportunity to reset the health and care agenda and instead, use this investment to create a person-centred, digitally-enabled NHS that will serve the British public for the next 75 years.
COVID-19 has likely moved the NHS on 5 years in terms of expediting technological and organisational progress by decimating red tape, forcing collaboration and engendering a public appreciation of the health and care sector that has reached an all-time high. This unique set of combining factors offers a chance to make significant progress in the journey towards person-centred and truly integrated care, but requires judicious policy choices across several areas.
The first focus area for the government should be redressing the balance between health and social care. Social care has a branding problem - whilst, as I alluded to in part one, the NHS is lauded and celebrated across the nation, social care is not nationalised in the same way, with no single, familiar institution for people to attach their affection to. Historically, health has been prioritised in terms of investment, strategy and leadership however, COVID-19 has for the first time seen care workers included in the narrative; whilst the podium at the daily briefings reads ‘protect our NHS’, we have seen regular mentions of care workers when the heroics of those on the frontline are detailed.
Effectively branding social care should go beyond the token gesture of a borderline patronising green badge and instead address the systemic disparities that exist. Andy Burnham has long extolled the virtues of establishing a ‘National Care Service’ - I believe this should be the long-term vision for social care. Before this can become reality, there are steps that must be taken following the pandemic to lay the foundations. This means utilising the much anticipated white paper on social care to establish a specific social care strategy, supported by Liz Kendall’s recent proposal to establish a Chief Care Officer overseeing its progress. This would serve to begin bridging the gap and start moving social care towards the parity with health it deserves.
Alongside these proposals for social care, there are material investments in the delivery of health services that could be utilised post-COVID to transform our NHS. Potential use cases include investment in primary and intermediate NHS estate to allow for increases in capacity during expected surges, like winter, as well as having provision for scaling up in response to any future pandemic scenarios. The collaborative relationships established during the pandemic response should be used as the catalyst for ending the uncoordinated development of individual sites and for primary care estate to become a core part of the wider strategy for delivering truly integrated care.
COVID-19 has forced clinicians and patients alike to rapidly adopt technological solutions, with those resistant to innovations such as digital GP appointments having to embrace this way forward. There has been a c.25% reduction in A&E attendances during the pandemic and whilst much of this demand is likely to return afterwards, there is an opportunity for targeted public health messaging encouraging alternatives to A&E, beginning with self-care and community services.
Lastly, the government can focus on solving the workforce crisis. The vacancy rates in health and social care are stark, with a projected 1 million vacancies by the year 2030. To contextualize this, for the gap to be addressed, 50% of the entire entrants to the workforce in the next 10 years would need to opt for jobs in health and care. NHS workers are currently enjoying public adulation on an unprecedented scale, with COVID-19 providing the ultimate opportunity to encourage young people to pursue a career in nursing, medicine and allied healthcare. This could be supported by Rachel Reeves’ proposed introduction of a new Royal College for social care, giving recognition to the expertise of these workers and protecting them from the punitive ‘unskilled’ label.
These policy recommendations are not a panacea and their success has many dependencies, including whether the newly collaborative relationships within systems are sustained after normality resumes. We all have a responsibility to ensure that COVID-19 is ultimately used as impetus for positive, transformative change and not as an excuse for the continuation of a broken system.
Charlie is a public sector strategy consultant and has lectured as a guest at the University of Manchester. He writes in a personal capacity.
 West D. Some hospitals left 'quiet' as covid-19 sparks huge fall in attendances [Internet]. Health Service Journal 2020 [cited 2020 April 25]; Available from: https://www.hsj.co.uk/acute-care/some-hospitals-left-quiet-as-covid-19-sparks-huge-fall-in-attendances/7027244.article
 Charlesworth A. Health and social care workforce [Internet]. The Health Foundation 2019 [cited 2020 April 25]; Available from: https://www.health.org.uk/publications/long-reads/health-and-social-care-workforce