CEO Blog September - Can Neighbourhood Health Deliver the Left Shift? (assuming we all agree what it even means)
Can Neighbourhood Health Deliver the Left Shift?
(assuming we all agree what it even means)
The NHS is going to move care out of hospitals and into the community. Yippee!
But will it? By my counting Neighbourhood Health is the eight major attempt to achieve the great NHS left shift…. stretching back more than 56 years during my career.
1976 priorities promised more emphasis on older people, mental health, and community services.
1990 NHS & Community Care Act ; help people remain in their own homes.
2000 NHS Plan; intermediate care, hospital-at-home services and 500 one-stop primary-care centres.
2006, Our Health, Our Care, Our Say; radical shift of services and resources out of hospitals.
2014 Five Year Forward View, Vanguard programmes.
2019 Long Term Plan; to finally dissolve the divide between primary and community services.
2022 Fuller Stocktake; integrated neighbourhood teams (but of course Fuller was told not to review GMS, premises etc.
2026 NHS 10-year plan.
None of these top-down initiatives has achieved the promised national, rebalancing of care. Hospitals by their nature still consume the lion’s share of NHS investment. Primary, community and social care have struggled for money, staff, and capacity. The funding imbalance is recognised by NHSE and ICBs but they seem powerless to change it if they have a strategy at all.
For anyone with half a brain, that many attempts should tell us something..... marching-on, with a new name, is just not going to work either. The Governments own impact assessment tells us all we need to know. ..a full assessment of costs and benefits was not feasible, the evidence is partial and the scale of the likely impact is difficult to assess.
In addition, successful integrated-care schemes have taken up to six years to reduce hospital use, and more importantly any improvements disappeared when additional funding ended. That all demonstrates the short-term vision of NHS leadership and clearly avoids the difficult questions around financial levers and longer-term investment plans.
DHSC and NHSE seem to have eagerly taken a policy almost as old as the NHS itself, given it a neighbourhood label and decorated it with numbers that it cannot prove. With ICBs withdrawing from the provider scene at some pace will it be left to the healthcare provider organisations to pick up the pieces and deliver the change if they can. Assuming we continue the current policy direction of Integrated Health Organisations holding the health (and social care?) budget for a defined population how will individual general practices (and PCNs) ensure they have the resources to survive and thrive with their current core contract?
One thing we should all remember is that moving care from hospital to community is not reducing demand. It is just relocating it! In this respect NHS policy is wrong in terms of its apparent definition of ‘left shift’. The biggest opportunity to improve health is finding new and better ways to look after people and stopping them getting there in the first place.
William Greenwood
Chief Executive