New approaches needed if the Long Term Plan isn’t to result in more of the same…

Most people won’t be surprised at the key messages in the Long Term Plan published on the 7th January, although there are admittedly some juicy bits to get your teeth stuck into like the commitments on prevention and health inequalities.  But, have we heard a lot of it before?  Are we indeed on the verge of a brave new world, or are there still things that will hold us back?

Perhaps the biggest challenge will be to enable the shift in the balance of funding away from hospital care with a corresponding, if not greater, shift in the focus and intensity of effort on the parts of the system that will act as catalysts for change.  The Plan describes a key ambition as being ‘a fully integrated community-based health system’, something heralded as a first since the NHS was created.  But targets, media and to some extent the incentives within our health and care provision continue to reflect an acute-focussed paradigm.  The astute observer will have wondered about the lost opportunity when the Plan was launched in an acute hospital!  You just wouldn’t start there if there’s to be a genuine shift.  And nothing short of a paradigm shift will effect the changes envisaged. 

In the same way, if our focus is on how we reprovide, prevent or shift services currently provided in hospitals to more community settings we’re at risk of starting in the wrong place.  So, instead of asking ‘what can we do in the community that has previously been done in hospitals?’ we should be asking ‘what’s the best way to support and care for people so that they don’t need hospital care?’  Subtle, but a powerful message, and whilst the need for acute care is unlikely to wither on the vine given population growth and public expectations (which is another story) we can at least be confident that we can plan for appropriate levels of specialist services confident that we’re not trying to close the stable door after the horse has bolted!

And so, if we are to genuinely develop a population led, place-based, integrated and whole system response to delivering on the Plan, then we need a different starting point.  Wider determinants of health, community assets and personalised care is where you start, not what you use to soak up ‘inappropriate acute care’.  You then wrap networks of support around individuals and their significant relationships, recognising the multiple and sometimes complex range of factors that will influence health and wellbeing.  When health needs emerge, as they will despite developing a strong place-based grounding for health and wellbeing, then Primary Care should remain the natural first point of call, and so the network grows and strengthens to ensure that health needs are met early and locally. 

Since the launch of the Five year Forward View WSP has moulded its offering to support this essential change in focus and built on our extensive transformation and partnership development work over the past 20 years.  The shift represents a complex set of changes that won’t be fixed simply by instigating a new set of targets, or even by pushing harder against a system that the Plan itself recognises as not being ideally designed for the needs of the twenty-first century.  WSP has learned much through our support to STPs, ICSs, Vanguards, CCGs, Local Authorities, Local Workforce Action Boards (LWABs) and national bodies such as the NAPC and CQC and believe that that learning is worth sharing more widely. 

What does that mean in practical terms?  Well it means the development of frameworks and tools that help systems to understand their local population health needs, have a focus on the future workforce needs as an integral part of strategic transformation, and are  based in system design methodology. It also means those frameworks and tools are rooted in and respect the need for strong relationships in an effective system that harnesses the power of simulation modelling.  Here’s a short list of six things that people are finding helpful:

  • Kent County Council and the Kent & Medway STP have found WSP’s population cohort modelling tool to be vital in complementing their JSNA offering, understanding the impact of prevention and in providing confidence in local demand and capacity modelling (page 33, section 2 of the Plan);
  • Derbyshire STP have found WSP’s conceptualisation of Place and approach to identifying place-based workforce requirements to be a valuable set of tools and frameworks  (page 14, section 1.9 of the Plan);
  • Understanding and meeting the needs of those who are frail or have complex needs is critical to the Plan, but equally important now, and more important for the medium to longer term, is understanding and addressing the needs of those progressing to this higher level of need – our ‘progression to frailty’ modelling, as a daughter product to the population cohort modelling is helping a number of local care networks to understand the needs of this population cohort;
  • The four CCGs across Medway, North & West Kent have found the development and use of WSP’s Local Care System Dynamics model to be critical to inform local care capacity building and investment plans;
  • CQC have found a relational component to their local system reviews ‘Beyond barriers’ to be of significant value (page 30, 1.52 of the Plan);
  • A number of CCG/STP footprints have now used the General Practice workforce simulator as a basis for planning the whole General Practice workforce, demonstrating one example of how workforce planning can be aligned to system transformation (page 78/83, section 4.4/4.26 in the Plan).

So, if a paradigm shift is needed to deliver the Plan, then there is also the need for the tools that help to refocus our attention on local populations, place, local care, relationships and an integrated workforce designed around future needs and service models.  We believe the six examples above, developed in the context of the learning from the FYFV and associated transformation programmes, are fit for that purpose.

 

Peter Lacey, Director
www.thewholesystem.co.uk