Health secretary Andy Burnham addressed NHS chief executives last week, and he used the opportunity to outline a five-year plan for the NHS. He described it as upbeat, gritty and realistic given the consequences of the downturn.
After outlining the progress that the NHS had made under Labour, he said the next challenge was to move the NHS from “good” to “great”. He acknowledged that: “At times, the system can still put its own convenience before that of its patients. It is not yet as good as it could be at promoting good health. We need to be better at early diagnosis. There is still too much variation in service standards and practice; too many people are spending too much time in hospital.
“In places, care has fallen below the standards that all patients have a right to expect. And, we must address all of this whilst adapting more rapidly to new pressures such as our ageing population and the increased prevalence of lifestyle diseases.”
On funding, he said: “The chancellor made clear that protecting the entire NHS frontline is his and the government’s priority. He confirmed that next year’s substantial increase will go ahead as planned and that this uplift will be locked in to frontline budgets for the two years that follow.
“This increase is coming from National Insurance - in the same way that patients elsewhere in the world have to pay higher private premiums to cover the growing costs of healthcare. But we think this is the best way to do it - a fair price to pay for to improve further the best healthcare system in the world.”
Burnham forgot to mention the Chancellor’s other pre-budget report comments affecting the NHS. Namely that public sector workers’ pay will be capped at 1% pay cap for two years from 2011. And contributions from the state to the pensions of public sector workers like chief executives and consultants will also be capped.
He then outlined a six point plan. “First, we will improve the payment system so that it rewards quality and puts patients first. A growing proportion of hospital’s income will be linked to patient satisfaction, rising to 10% of their payments over time. This is a symbolic shift towards the people-centred service I want to see, a service which at times thinks about how things look through the eyes of the patient their family. Poor or unsafe care will not be tolerated - and payments will be withdrawn if care does not meet minimum standards.
“Second, we will provide more choice for patients, giving them the ability to register with a GP wherever they choose by abolishing practice boundaries, an option of seeing a doctor in the evenings and weekends in every area, and more access to services - like chemotherapy and dialysis - at home or in the community.
“Third, more work will be taken out of hospitals. As part of this, we will provide dedicated carers for patients with cancer or serious long-term conditions who can benefit from a more personal approach to nursing. We expect all parts of the NHS to continually review the way long-term conditions are managed and to seek out and adopt best practice. Where appropriate this should include the provision of personalised one-to-one support by a health professional, particularly for more complex conditions. We will consider and cost the possibility of a patient entitlement in this area. This will benefit millions of people. We will also introduce a three-digit national non-urgent number to reduce pressure on hospitals.
“Fourth, there will be new rights to high quality care - including the right to see a cancer specialist in two weeks for urgent cases, and in time, a one-week wait for crucial tests. We will propose the right for patients to die at home. Choice and dignity at the end of life is the mark of a civilised health system. The NHS will ensure a dying patient can choose where they wish to spend their final days.
“Fifth, we will provide more freedom for hospitals. The best NHS foundation trusts will be free to work across a wider area. We will encourage high-performing foundation trusts based in one area to provide both acute and community services in other areas, if the PCTs in those areas want to commission from them. And we want to see more integrated provision across the entire patient pathway. We open the possibility of acute trust providing GP services, if safeguards can be found.
“And finally, we want the NHS to intervene earlier and prevent more disease. I do not want to see history repeated and prevention to be the first thing to go in tough times. Promoting physical activity, as I said before, should be core business for the NHS. We will press on with the ground-breaking NHS Health Checks programme for people between 40 and 74. We will provide access to personal care plans and health-checks for anyone suffering with a long-term condition. Patients will be invited to discuss and agree their care plan with their clinician, giving them a greater say in their care.”
Burnham finished by offering chief executives one of his trademark deals: “As we go through this change, we will support them and empower them to make the changes we need. I will explore whether we can maintain frontline employment across a locality or region - in return for flexibility, mobility and sustained pay restraint.”
The parting message - play ball or face cuts.
Commenting on the plan, Dr Hamish Meldrum, chairman of council at the BMA, said: “We welcome the government’s commitment to maintaining NHS funding in England and to protecting frontline services. However, the scale of the challenge in carrying out many of the plans in this document should not be underestimated. Redeploying budgets and staff, or reconfiguring services, is never straightforward.
“NHS staff are pivotal in delivering effective services to patients, and we welcome the Health Secretary’s commitment to supporting and engaging with us. The BMA will respond positively to such engagement. However, the repeated talk of pay restraint when what is really meant is no pay rise at all, is demoralising. While healthcare workers clearly understand the financial pressures on the NHS, and will want to act responsibly, they should not be punished for a situation which is not of their making.”
Read the full report.