As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Niall Dickson, chief executive of NHS Confederation
This July is not just an opportunity to celebrate the stories and innovations which define the NHS of the past, but what it will become in the future. If we were to speak again in ten years’ time, what recent or current changes/developments do you think will define the immediate future of healthcare in the UK?
We are at a watershed moment in the history of the NHS and with the Prime Minister’s recent funding announcement, it is important we make the right moves for the future. This is an opportunity not to simply prop up the existing system but to transform.
A renewed focus on place is key. Systems need to be simplified, locally led and patient centred with care shifted away from hospitals and into the community. People need to be able to get the right treatment, at the right time, in the right place.
Further advances in treatment and technology will influence the way patients are cared for and the way they access services, including an increasing ability to use information and data about each individual. For example, DNA profiling could identify individual risk factors, while real time health monitoring could take, transmit and interpret dozens of measurements on a routine basis.
Much has been made about a need for an increase in social care funding. With services becoming more integrated and joined-up, how important is it that a sustainable and radical reform of the current system is soon established?
Health and social care are sister services and, put bluntly, a solution for one but not the other simply will not work. Totally inadequate social care funding is leaving demand unmet and thousands of older people without the care and support they desperately need. Yet successive governments have ducked the question and it remains dangerous political territory.
A funding boost is needed to address inconsistent provision across the UK, and tackle rising numbers of people with unmet care needs which has led to increasing reliance on unpaid care from friends and families.
In the next 15 years, there will be 4.4 million people in the UK aged 65 and over. The number aged over 85 is likely to rise by 1.3 million. We are also seeing more people living with multiple chronic conditions. Yet spending on adult social care has fallen since 2009-10.
Our report with the Institute for Fiscal Studies and the Health Foundation, Securing the future: funding health and social care to the 2030s, says 3.9 per cent annual increases in social care spending would be the minimum needed, just to continue the current level of service provision for projected demand for social care services.
There is demonstrable public support for it too. An Ipsos Mori poll indicated 82 per cent of British people would support a 3.9 per cent funding increase for social care.
When you became chief executive of the NHS Confederation at the start of last year, you said that there has never been a more important time for the healthcare systems various parts to come together locally and nationally. In the last 18 months, how much closer have we come to achieving that intention? And what do our next steps look like?
There are certainly outward signs that the system is taking steps both at a national and local level to bring different parts together. One obvious sign is the recent steps taken by NHS Improvement and NHS England to work more closely.
At a local level, our members are keen to see a different model which is system-wide, longer-term and place-based. The key to delivering this reform lies in developing solutions that bring the whole system together.
Progress has been made on integrated systems with senior leaders working together and building relationships and, in some instances, we are even seeing organisations co-locate teams with staff from social care, mental health, community and primary care.
But many are still struggling to bring about fundamental change while their leaders are preoccupied with immediate operational and financial challenges. We will need legislative change. Much of what is being attempted now amounts to workarounds and local fixes.
As part of the recent Confed18 conference, the top 70 health and social care ‘standout stars’ of the last 70 years were recognised for their contributions to the NHS. As well as exceptional individuals, in your opinion, are there any standout achievements or changes of the last 70 years that deserve special recognition?
The very concept of the NHS has rightly been described as one of the great social achievements of the 20th century with its promise to care for the British people from cradle to grave.
70 years ago the cost of medical care was a source of real worry and fear for many families and something which some simply could not afford. At the end of the Second World War everyone agreed something had to be done and the answer came in the form of a state funded National Health Service.
It was a controversial model but one which soon became accepted, in broad terms, both by politicians and professionals. Over the years we have seen crises and criticism but one principle has remained almost unscathed: that healthcare should be funded from general taxation and available to all free at the point of use.
You said in May that NHS England and NHS Improvement working more closely together has the hallmarks of good move. Looking to the future, where else can the health system encourage and adopt collaboration and integration as a way of increasing closer dialogue and improving patient care?
The need for care to be joined up around the needs of patients has never been greater and this means further integration between health and social care services.
The relationship between local government and the NHS remains variable but it is incumbent on everyone to work together much more closely than in the past, recognising the interdependency of health and social care. The future lies in devising jointly agreed, practical measures that will support patients in the community, prevent unnecessary admissions and reduce delays around discharge.
We have to acknowledge that the Better Care Fund was always a ‘work around’ and our shared goal must be to devise a better long-term solution that goes beyond temporary fixes and has the confidence and support of both the NHS and local government.
Ultimately this is not about what is best for local authorities, social care providers or the NHS - it is about how can we make a difference to those who too often are being let down by a fractured system.
Jeremy Hunt has recently become the longest serving Health Secretary, having been put in that role in 2012. Adopting a more political stance, is there any advice that you would give to him moving forward?
The Secretary of State has provided a degree of continuity at a difficult and uncertain time. He should be congratulated for his role in persuading the Prime Minister of the need to provide additional funding for the NHS.
It is important now he helps create the space to allow for proper planning on how the money should be spent. The plans need to be credible and realistic and to do this, they need to draw on the views of the managers and clinicians who are responsible for commissioning and delivering the care.
A key task now will also be to live up to his new title as Secretary of State for Health and Social Care, and focus his attention on the long delayed and much-needed reform of social care. This will take political courage but the prize is have tackled the social issue others have lamentably failed to address.
Niall Dickson is chief executive of the NHS Confederation, which represents organisations across the healthcare sector. Niall has served in some of the most prominent national roles in health and care. Before joining the NHS Confederation, for seven years he was the chief executive and registrar of the General Medical Council and before that for six years he was the chief executive of the King’s Fund. For sixteen years, he was a senior correspondent for BBC News, latterly as Social Affairs Editor.
source: Health Business News
As part of July’s NHS 70 anniversary celebrations, Health Business will be publishing a number of interviews with those working within and for our health service. Here, we pose some questions to Janet Davies, chief executive and general secretary of the Royal College of Nursing
The face of nursing today looks very different from how it did when the NHS was first created 70 years ago. What would you say have been the biggest changes over that period?
There has been enormous change but the motivation of nurses - enabling people, empowering people, caring for people with compassion - remains exactly the same. What motivated our nurses in 1948 is exactly the same as it is now. But healthcare and health need has changed beyond all recognition. Nurses can now be found leading cutting edge research, prescribing drugs, running clinics, and holding top management positions both in the NHS and independent sector. Specialisms exist now that would have been unthinkable at the beginning of the NHS, and it is not unusual to find specialist nurses training junior doctors in certain areas. The population and patient need is great and growing so we have now been left in the position where we don't have enough nurses. As the needs of the population become increasingly complex, the profession must continue to rise to the challenge.
At such an important time for the nursing, midwifery and AHP workforce, how is the nursing industry responding to some of the challenges that it is facing in 2018?
It’s been a long time coming, but the industry is at last beginning to respond to calls for a more flexible way of working that places greater emphasis on staff well-being. Nursing staff have a right to a healthy work-life balance, and flexible working opportunities not only improve staff performance and reduce unplanned absences, but support the recruitment and retention.
The RCN has long been campaigning to improve conditions, particularly around nurses missing rest breaks, and lack of access to food and drink. These issues have only become more pressing, as understaffing has left too few nurses covering depleted rotas and trying to do the best they can. In these circumstances it can be difficult to find time for breaks, but they are vital, both for the safety of nurses and their patients. Dehydration, for example, affects concentration, which triggers fatigue - essentially as it is not just a well-being at work issue but an issue of safety.
RCN guidance spells out the duties employers have to staff, but also provides clear, practical steps employers can take to make sure staff are able to look after themselves properly, and by doing so provide the best care to patients.
Alongside other health professions, leading figures within the nursing sector have commented on the need for services to improve. Realistically, what does improvement look like?
Training is key to improvement, yet too many nurses have had career development opportunities snatched away as the Health Education England budget for continuing professional development has been cut by 60 per cent over the past two years, from £205 million in 2015/16 to £83.49 million in 2017/18.
Nurses make up half the NHS workforce and, as a society, we cannot afford for their training to be an optional extra. These short-sighted cuts must be reversed. For the sake of patient safety, nurses must be allowed to keep up-to-date with developments and advanced into tomorrow’s nurse leadership positions.
Within the history of the NHS, given current problems, one thing that stands out is the magnitude of nurses who have come from overseas and made a contribution to improving care in the UK. This is highlighted with the 70th anniversary of the arrival of Empire Windrush this year as well. Just how important is it that staffing shortages are adequately addressed, both inside and outside of the UK?
The NHS has a proudly international history and even now its staff are drawn from 200 countries around the world. But, following the Brexit vote, our European nurses have put up with two years of uncertainty, mixed messages and even being used as ‘bargaining chips’. There are 40,000 unfilled nurse jobs in the NHS in England alone and that number would rise further if EU nationals felt no choice but to leave. Nurses returning home, or giving Britain a miss entirely, are doing so because their rights are not clear enough. Theresa May must use every opportunity to say they are welcome here and valued in health care.
Starting to stem the loss of nurses is welcome but the real battle is to inspire young people to join the profession. We need to grow our domestic workforce, and it is vital the Government does more to encourage people to study nursing, through incentives and financial support.
Staffing shortages are the most serious problem affecting not only the nursing profession, but our healthcare system as a whole, because it has a direct impact on patient care. We need a comprehensive, long-term workforce strategy which determines the real demands that our ageing growing population places on health and care services.
And it’s not enough to stop at the NHS. Given the significant proportion of nurses needed across all sectors, any plan based solely on the NHS, or even the wider public sector, will likely fail. There need to be enough trained nurses in our country that an individual choosing to pursue a career in the independent sector has no detrimental impact on the NHS – tens of thousands of nurses work in social care.
The knowledge and skills required from registered nurses today are obviously very different from what was required ten years ago, never mind 70 years ago. With this change likely to continue into the future, where does the sector go from here? What do you expect to change in the next decade?
The UK is behind some other countries in its use of artificial intelligence and robotics in healthcare, but we expect to see greater use of technology in healthcare. This must be managed to ensure patients, and the nurses who care for them, see genuine benefits. Several hospital pharmacies in the NHS are now using robots to pack prescriptions and reducing dispensing errors. Meanwhile the Edinburgh Centre for Robotics is currently developing SoCoRo, a ‘socially competent robot’, to ‘deliver behavioural training’ for adults with Autism Spectrum Disorder.
But increasing use of technology must work in harmony with the profession, not against it, and the RCN is working to understand the challenges and opportunities the future holds for nursing.
Janet Davies is the chief executive and general secretary of the Royal College of Nursing. Janet is a mental health nurse by background who, prior to joining the College, was a Director of Nursing and then chief executive of an Ambulance Trust.
source: Health Business News
To help mark the NHS’s 70th birthday, the BBC is broadcasting a season of programmes that started on Monday 25 June. Catch them on the iPlayer.
ITN have worked with NHS teams across the country to produce a current affairs-style programme looking back at 70 years of innovation. Presented by newsreader Natasha
Kaplinsky, it covers day one of the NHS story right up to the people driving change and best practice now.
View it online here