Survival and Recovery Plans

Reading many Sustainability and Transformation Plans leads to the conclusion that what we need are Survival and Recovery Plans.

Every day brings more reports of failings in the care system. Every STP sets out starkly a set of challenges that have to be met. Every commentator and think tank agrees the system cannot meet our expectations without further funding, which the government says is not coming.

Survival ought to be about getting through the winter without system failures.

Recovery ought to be about getting back to meeting all the NHS targets (A&E, Ambulance, Cancer, Referral to Treat Time) and having all trusts in financial balance and injecting the funds that social care requires even to stand still. If there was significant additional funding in social care and in the NHS in 2017/18 then this might be achievable – the increase though would be of the order of £5 billion above what is promised.

Only when the system is back onto solid foundations should there be any attempt to transform it. That is like rebuilding the engines whilst the plane is flying. The idea that the transformation will solve the short term crisis is anyway just wrong – and nobody believes it. Stopping doing some things and concentrating on those few things that can make a short term impact is the best hope.

During this period of perhaps 18 months (perhaps 30) a lot of good work could be done on engagement consultation and then planning for taking the STPs forward. In some places more could be done earlier if recovery was achieved and if public support was forthcoming. Maybe there could be some sensible discussion of the long term funding issues.

There is also a genuine public interest case for delaying the STPs; since they move the care system onto a very different delivery model. This is not about unpicking the Lansley “reforms” or even the Ken Clarke 1980s commissioner/provider split or the New Labour changes. It is about unpicking the original 1948 settlement.

We see an end to the NHS. It is no longer as national as it used to be with lots of devolution and delegation. It is no longer health its care or better still wellbeing. And it’s no longer a service it’s a system.

We move from a medical model to a social model of care. The distinctions between primary/secondary/community/social care become meaningless. As some envisaged in 1948 there will be locality based services operating out of care centres/hubs and with multi-disciplinary teams. These teams will also move outwards to provide much more care and support in the home or close to the home. Community hospitals will become less hospital more community hub. GP practices will be merged into the hubs or otherwise aggregated into federations. Urgent and emergency care is joined up! Acute hospitals will have no long stay patients and ambulatory, day case and very short stays will be the norm. Increasingly short term episodic acute care will be provided in fewer locations and there will be fewer A&E departments, but more Urgent Care Centres. Staff will be expected to be moved across the system without organisational boundaries being an obstacle – even hospital based consultants.

Underpinning the new model will be modern information systems allowing access to patient data anywhere anytime (if authorised); better telecare; planning on a place based approach; and an end to commissioning as we know it. As of now it’s all a bit vague about accountability and funding flows.

Still this is the biggest change in our care system since 1948; it’s a huge opportunity and poses major risks. If we are to give it a go let’s build public support first.