The consensus from the speakers at last week’s Westminster Forum was that the Long Term Plan (LTP), as a plan, is good. It is solid, it is forward thinking, and it seeks to solve a number of key issues the NHS is facing. These include positioning care for patients where it is most needed to help reduce non-emergency admissions to emergency care, joining up care pathways to optimise patient care and outcomes and having a focus on specific health areas that require immediate focus such as mental health and diabetes. Unlike previous plans, the plan also sets out how these can be achieved. A criticism is how the plan can and will be resourced from a workforce perspective, and how we make the changes acceptable to patients and the general public.
Structural and cultural change
The LTP relies on NHS staff currently operating in a ‘command and control’ environment to switch to working in cross-functional, multi-disciplinary teams where people are deployed and responsible for delivering to a role that best suits their training and skills. The LTP covers this in Chapter 6 ‘Enabling productive working’. This will be different to the current structure, where, for example, the community pharmacy role has become more concerned with retail and being the commercial face of medicine. Pharmacists could, under the LTP, realise their true potential as skilled medicine and health advisors, able to ease the load currently sitting at the GPs door. GPs are seeing patients whose first port of call should be, for example, a pharmacist, a counsellor or a physio. The gatekeeping role of general practice is hindering the average GP from realising their full skills potential. Part of this is due to ingrained public perception as the GP is the first port of call for anything from a sprained wrist to a troublesome, lingering cough. Public Health England (PHE) has started on this journey with a new campaign for allied health professionals, including pharmacists to advertise their skills to the public via a range of downloadable communications materials.
Developing a new narrative
How can everyone help the LTP succeed? There is a real need to develop training and acceptance of new responsibility, for which the PHE campaign will certainly help, along with creating a strong narrative across the NHS that credits patients with seeking out the help they require from different HCPs within the NHS. Going back to the pharmacy example; pharmacists have become the shopkeeper of medicines, and the LTP seeks to bring them out of their shop and into the GP surgery. The LTP looks to shift the route for patients to access non-urgent advice and this requires a change in mindset and behaviour in delivering care as part of Integrated Care Systems (ICSs), and storytelling can play an important role in this shift.
There are effective ICSs operating already, and some of them are getting ready to share their successes and prove how new operating systems can improve patient care. Positive stories and narratives should be shared beyond the individual hospital trust or trusts to encourage other trusts to adopt new ways of working and break down silo working. Encouragement for sharing and openness are required to adopt approaches that other teams in different localities have taken to achieve success. This approach will save time and resources that would previously have been spent reinventing the wheel. Niall Dickinson, Chief Executive NHS Confederation, suggested at the forum that the NHS should look towards industry, who aren’t afraid to borrow and steal ideas from others to help advance their cause because a lack of adaptation risks loss in business. There are fewer so-called ‘second adopters’ (being the ones who adopt after the ‘early adopters’ in the health system. NHS England Innovation, the Modernisation Agency and the Academic Health Networks, among others, do a great job in encouraging sharing of best practice, and industry, working with agencies like Aurora, also help to encourage and provide impetus to share the excellent practice that is happening. To encourage sharing we need a series of positive stories to tell and champions of change who can deliver clinical leadership and show improvement in patient outcomes and reduction in health inequality.
Helping the public navigate the new system
And where in all this change is the patient? That question was asked of the speakers at the forum. The LTP needs patients to be motivated enough to seek out new ways of self-managing conditions and to learn new ways of navigating a changing NHS. Underpinning this they need belief that an evolving NHS will transform for their benefit. To instil belief, we need to tell positive stories of transformation. As a patient with chronic illness myself, I am more than happy to see a pharmacist or nurse who can refer me to a specialist HCP rather than wait to see my overloaded GP.
To ensure smooth running across ICSs, there is a piece missing which was touched on at the Forum: digital and tech improvements to communications. It’s the King’s Fund annual digital health and care congress in May where Rt Hon Matt Hancock MP will deliver a keynote address and we should expect to find out more about the extent to which digital improvement is actually possible throughout the NHS. There are, as with ICSs, pockets of good practice when it comes to implementing and rolling out digital communications, but there is a long way to go to make digital a positive word in the NHS.
My key learnings from this conference are:
- That there is positivity from people in the know that the Long Term Plan can deliver
- To succeed there needs to be openness to sharing and adopting best practice, enhanced storytelling of the successes within the NHS and ultimately belief that success can be translated across teams and regions.
At Aurora we have experience of working with teams across the health spectrum who are delivering best practice, helping them share their story. If you’d like to find out about ways we can help, contact me at firstname.lastname@example.org or call on 020 7148 4170.