Their view? The new government has got off to a slow start and needs to come through with a realistic plan for the future of health and care with technology as a key enabler. <\/strong> <\/p>\n\n\n\n If Rishi Sunak had gone to the polls when political correspondents predicted that he would, the UK would have been voting at the start of November. However, he called an election in May, the country voted on 4 July, and Sir Keir Starmer had been in his job for four months by the time bonfire night rolled around. <\/p>\n\n\n\n Yet shadow chancellor Rachel Reeves ruled out the most obvious ways to raise taxes. So, Labour made the electorate a \u2018retail offer\u2019 of an additional 40,000 appointments per week to tackle waiting lists, paid for by a crack-down on \u2018non-doms\u2019, while insisting there would be no further money without \u201creform.\u201d <\/p>\n\n\n\n Buying time <\/strong> <\/p>\n\n\n\n When he arrived at the Department of Health and Social Care, new secretary of state Wes Streeting announced that \u201cthe policy of this is that the NHS is broken.\u201d He also announced an independent review by Lord Ara Darzi, a surgeon and health minister in Gordon Brown\u2019s government. \u00a0<\/p>\n\n\n In September, Lord Darzi made headlines by declaring that the NHS \u201cis in serious trouble.\u201d But health tech entrepreneur Ravi Kumar said: \u201cthere is nothing in there that will surprise people who have been in and around the NHS.\u201d <\/p>\n\n\n\n \u201cThere were no surprises in there,\u201d agreed David Hancock, an interoperability expert who has worked for both shared care record and electronic patient record suppliers, \u201cso why do it? The only reason was to buy time.\u201d <\/p>\n\n\n\n Cindy Feddell, a former NHS CIO who now works in Canada agreed, although she felt more urgency was needed. \u201cI thought they would have used the review to launch a plan, but they didn\u2019t,\u201d she said. \u201cIt\u2019s very disappointing, because it is a plan we need, not more strategic reviews.\u201d <\/p>\n\n\n\n Diagnosing NHS Failure <\/strong> <\/p>\n\n\n\n Lord Darzi did make a diagnosis of the NHS\u2019 problems that could feed into the 10 Year Health Plan due next January. He argued the root of its challenges lie in the austerity politics of the Cameron\/Osborne era, that starved public services of money while driving demand. <\/p>\n\n\n\n He argued these issues were exacerbated by the \u201ccalamity without international precedent\u201d of health secretary Andrew Lansley\u2019s reforms in 2012, which fractured NHS structures in a last-ditch attempt to drive competition across the system. <\/p>\n\n\n\n But he also noted that the governments that came before and after these changes have talked about \u2018left shift\u2019 reforms without making them stick. <\/p>\n\n\n\n Lord Darzi argued one reason is that they failed to align funding flows with these changes. Plus, he noted, it has become routine to transfer capital funding to the \u2018frontline\u2019 \u2013 leaving the NHS with crumbling facilities and \u201cstuck in the foothills of digital transformation.\u201d <\/p>\n\n\n\n Reform talk and reality on the ground <\/strong> <\/p>\n\n\n\n When Streeting talks about \u201creform\u201d these days, he talks about three shifts: from hospital to community, from treatment to prevention, and from analogue to digital. <\/p>\n\n\n\n However, Nicola Haywood-Cleverly, a former chief information officer and trust non-executive director, noted there is a big gap between where the NHS is now, and where these three shifts would take it. <\/p>\n\n\n\n At the moment, she said, NHS England is focused on waiting lists and financial discipline, even if this means cuts in staff or services that pull in a different direction. \u201cI want to know what is going to be different,\u201d she said. <\/p>\n\n\n\n \u201cAt the moment, my main concern is there might be a gap between what the Operational Priorities and Planning Guidance [which sets out NHS England\u2019s \u2018must dos\u2019 for the service] and the 10 Year Health Plan might say.\u201d <\/p>\n\n\n\n Budget smoke and mirrors <\/strong> <\/p>\n\n\n\n This gap was not closed by the much-anticipated Budget delivered by chancellor Rachel Reeves in October. To fill the \u201c\u00a320 billion black hole\u201d in this year\u2019s public finances, invest in infrastructure, and stabilise public services, Reeves raised taxes by \u00a340 billion and borrowing by \u00a370 billion. <\/p>\n\n\n\n Around half the headline tax increase will go to the NHS, which was promised \u00a322.6 billion over two years. However, this year\u2019s \u00a310.4 billion includes a \u00a31 billion transfer from the capital budget and \u00a31.8 billion for waiting list initiatives announced in the summer. <\/p>\n\n\n\n What\u2019s left will have to cover financial pressures of around \u00a34.8 billion, drug and pay pressures, including changes to employer National Insurance contributions. <\/p>\n\n\n\n \u201cWhat came out of the Budget was smoke and mirrors, again,\u201d said James Norman, who worked in NHS finance and as a trust CIO and who now works on the supplier side. \u201cIt is just covering the pressure that is there; there is nothing new coming down the line.\u201d <\/p>\n\n\n\n In fact, he argued, it\u2019s worse than that, because NHS employers will be covered for the NI changes, but the GPs, third sector, and social care providers who will have to deliver any shift from hospital to community and prevention, won\u2019t. Another example of how talk about reform and reality on the ground are pulling in different directions. <\/p>\n\n\n\n Capital funding mirrors and smoke <\/strong> <\/p>\n\n\n\n The Budget also made a big deal out of promising more capital spending. An additional \u00a33.1 billion was added to next year\u2019s capital budget, taking it to \u00a313.6 billion. Of this, \u00a31.5 billion has been allocated to capacity increases, including additional beds, surgical hubs, and scanners, and \u00a32 billion to \u201ctechnology and digital.\u201d <\/p>\n\n\n\n However, the advisory board noted that while Streeting talks about a shift from analogue to digital it is virtually impossible to invest in the current climate. \u201cDigital leaders are saying they cannot do anything without going through two or three layers of governance outside their own organisations,\u201d said Nicola Haywood-Cleverly. <\/p>\n\n\n\n \u201cThat makes it very hard for suppliers to build a pipeline.\u201d Many trusts are having to freeze vacant non-clinical posts to manage system deficits, reducing their capacity to digest innovation and transformation.<\/p>\n\n\n\n Meantime, it is unclear whether Reeves\u2019 tech spending is new money or, in effect, a re-announcement of the \u00a33.4 billion that her predecessor, Jeremy Hunt, announced for NHS digitisation in March. Certainly, the Treasury \u2018red book\u2019 makes no mention of the latter. <\/p>\n\n\n\n Left shift, acute capture <\/strong> <\/p>\n\n\n\n For the advisory board, though, the big question is how the money that is available will be spent. Rizwan Malik, imaging leader, picked up on the promise to invest in community diagnostic centres and scanners. In principle, he argued, this could help to \u2018left shift\u2019 services into the community; but in practice many CDCs and new scanners have been attached to acute trusts. <\/p>\n\n\n\n Nicola Haywood-Cleverly argued there are similar issues with virtual community and urgent health care. Some of the innovative projects developed during the Covid-19 pandemic have morphed into virtual wards overseen by acute trusts \u201cso primary and community-led care in its purest sense has been diluted, and become part of the old way of doing things.\u201d<\/p>\n\n\n\n Integrated care boards were set up to create joined up services that still found room for both health and social care providers and innovative ideas. But, as Lord Darzi pointed out, NHS England\u2019s policy focus and funding flows have not moved in the same direction \u2013 and nor has investment in IT. <\/p>\n\n\n\n Where\u2019s the enabling tech? <\/strong> <\/p>\n\n\n\n The Treasury red book says Reeves\u2019 \u00a32 billion will \u201crun essential services and drive NHS productivity improvements\u201d while making sure that all trusts have electronic patient records, the NHS has better cyber security, and there are enhancements for the NHS App. <\/p>\n\n\n\n James Norman pointed out it makes no mention of some of the big, enabling technologies that will be needed to \u2018left shift\u2019 services and loop in innovative providers or social care. \u201cWhat has happened to the shared care records?\u201d he asked, as one example. <\/p>\n\n\n\n \u201cThey were meant to connect care, by integrating data and letting people see information relevant to them. But in some places people have backed them while in others they\u2019ve been put in at a minimal level and nobody is using them. What\u2019s the plan?\u201d <\/p>\n\n\n\n Big projects, brownfield sites <\/strong> <\/p>\n\n\n\n Just before the advisory board met, the DHSC announced that eleven \u2018enabler\u2019 groups have been set up to feed into the 10 Year Health Plan. Encouragingly, there is a digital group, led by NHS England chief data and analytics officer Ming Tang and former national director of transformation Tim Ferris. <\/p>\n\n\n\n However, Ferris is best known for launching the Frontline Digitisation programme to complete the deployment of EPRs at trusts and Tang is leading on the roll-out of Palantir\u2019s Federated Data Platform, which suggests the group may focus on acute IT. <\/p>\n\n\n\n It could also go looking for a \u2018big project\u2019. The Tony Blair Institute for Global Change has been making a lot of noise about creating a single, digital health record for every UK citizen within five-years. <\/p>\n\n\n\n But it has failed to answer questions about whether it would build on initiatives like shared care records, or junk them. Advisory board chair Jeremy Nettle raised a similar issue about the NHS App. When it was set up, the app was billed as a \u201cdigital front door\u201d for the NHS. <\/p>\n\n\n\n Then NHSX decided it should just provide identity and login services and sign-post people to third-party apps. Now, it\u2019s a mishmash of login and basic functionality; a lot of which is dependent on what GPs allow their patients to see. <\/p>\n\n\n\n \u201cThe NHS App shows that it is not just technology that matters,\u201d he said. \u201cIt is how it is deployed and how it is used. You need a roadmap and consistent investment to deliver.\u201d <\/p>\n\n\n\n One plan, with technology at its heart <\/strong> <\/p>\n\n\n\n The advisory board also felt that it would be a mistake to develop a 10 Year Health Plan with strategies to support it. Past experience suggests these strategies too easily become menus of options, from which ideas are funded or not-funded according to political interest and the finances available. <\/p>\n\n\n\n Instead, the board argued there should be one plan, that explains how the finance, workforce, and technology available will be used to enable its direction of travel. \u201cWe shouldn\u2019t have a 10 Year Health Plan and a tech strategy to go with it,\u201d James Norman argued. \u201cThere should be one plan that says how technology will be used to deliver.\u201d <\/p>\n\n\n\n Unfortunately, as Jeremy Nettle pointed out, that won\u2019t be easy to achieve. \u201cThe NHS may not be broken, but it\u2019s certainly unwieldy, and its integration with social care is complex, and both are subject to a lot of different pressures that will need sustained effort and investment to address,\u201d he said. <\/p>\n\n\n\n And what about social care?<\/strong> <\/p>\n\n\n\n Social care is a crisis of its own; one that is threatening to bankrupt councils and providers, while not providing adults the care they need. After the main board meeting, Jane Brightman, a social care expert with a special interest in technology, said there had been some measures for the sector in the Budget. <\/p>\n\n\n\n These included \u00a3600 million of new grant funding for local authorities, an \u00a386 million increase to the Disabled Facilities Grant to support 7,800 more adaptations to homes to reduce hospitalisations and prolong independence, and an increase to the Carer\u2019s Allowance weekly earnings limit from \u00a3151 a week to the equivalent of 16 hours at the National Living Wage (which means carers can earn over \u00a310,000 per year). <\/p>\n\n\n\n There was also an extra \u00a3250 million to test new ways of working in children\u2019s social care next year, including a pre-announced \u00a344 million to test allowances for kinship carers and to roll out regional hubs to support the recruitment of foster carers. <\/p>\n\n\n\n Despite these measures, she said there is significant concern that this will not make a dent in the sector\u2019s current problems, or the ones being stored up for the future. The increase in employer National Insurance contributions will also hit the sector hard and could swallow up any additional funding on offer. Despite Labour\u2019s missions to improve and its talk about reforming health and social care, a Fair Pay Agreement for social care workers and a National Care Service have not featured in its first months in government. \u201cBoth ideas are welcomed by the sector, but too far down the road to provide the hope that is much needed right now,\u201d Jane said.<\/p>\n","protected":false},"excerpt":{"rendered":"\n The NHS emerged as an election issue during the campaign, which posed a challenge for Labour. The party knew it was going to inherit an economy with low levels of growth and high levels of debt. It also knew the NHS was struggling and \u2018unprotected\u2019 public services were facing cutbacks on an undeliverable scale. <\/p>\n![\"\"](\"https:\/\/www.gpsj.co.uk\/wp-content\/uploads\/2024\/11\/LONDON-WESTMINSTER-60-1024x683.jpg\")
<\/figure>\n<\/div>\n\n\n