Policy Update - Taking stock after the general election
Now that the dust has settled following the election of a new UK parliament and the formation of the Conservative Government, it is time to take stock of the policy landscape and the prospects for some of the policy priorities identified by the BGS prior to the General Election. The focus in this article is on England. Policy issues in Scotland, Wales and Northern Ireland will be considered in future articles in the context of devolved Assembly and Parliament elections taking place in May 2016.
The BGS had called on the incoming Government to end the divide between free health care and means-tested social care. Though the divide remains, the number of stakeholders calling for free social care at end of life is growing and that pressure point is a potential source of change in the future.
Regarding broader aspects of integrated care, all eyes are now on the NHS Five Year Forward View which the Government has endorsed in the Queen’s Speech. There are already 29 ‘vanguard’ sites piloting new care models within parameters set out by the Forward View. Of these, nine are Integrated Primary and Acute care systems, intended to join up GPs, hospitals, communities and mental health services; thirteen are Multi Speciality Community Providers intended to move specialised care out of hospitals into communities; and six provide Enhanced Care in Nursing Homes, intended to offer older people better joined-up health, care and rehabilitation services. Many members of the Society have been implementing innovative care models pre ‘Vanguard’. Others are now participating in the work of the Vanguard sites.
As the Nuffield Trust has highlighted, the NHS lacks a consistent approach to effectively monitoring innovation and distilling reliable evidence about “which ideas make progress towards the desired outcomes”. This is an issue for the Vanguard sites in general but also relevant to members of the Society who are involved in the delivery of innovative care models. They are continually building tacit knowledge and insights that are relevant to the policy narrative taking shape in the context of Five Year Forward View. Key policy themes include the relationship between specialists and generalists in healthcare; the promotion of self-care and patient control; flexible and multi-disciplinary team working; systems approaches to the management of frailty, multi-morbidities and complex needs; care closer to home (with obvious implications for intermediate care); the access of nursing home patients to healthcare and the support and training needs of nursing home staff. The policy narrative that is now being shaped is ripe for fresh input from the perspective of professionals with expertise in the healthcare and support of older people. The challenge is to ensure that their local level learning is harvested and disseminated nationally.
Before the election, the BGS also called for adequate investment in healthcare and social support for older people. The Government’s commitment to invest an additional £8 billion per annum in the NHS has been welcomed but outstanding questions remain, not least about the £22 billion in efficiencies required of the NHS over the next five years. There are major concerns about the funding gap in social care, estimated to reach £4.3 billion by 2020. As BGS members know better than anyone, older people’s access to end-to-end care pathways is entirely dependent on effectively functioning and aligned health and social care systems. The Summer Budget on July 8 will reveal more in terms of the Government’s intention to cut £12 billion from public expenditure but, at time of writing, the prospects are for a deepening crisis in social care with negative consequences for older people and their carers.
Another election promise generating considerable heat is the commitment to a 7 day NHS and 7 day GP access. This promise has been followed by a focus in public debate on the shortage of GPs and nurses. These are serious issues but, from a workforce skills and planning perspective, a broader focus is needed. One of the BGS calls has been, and will continue to be, for staff across all care sectors to develop competencies in the management of older patients. We have work to do to ensure that this message builds traction over the lifetime of the new Parliament.
Finally, the BGS had called on the incoming Government to measure the dimensions of care that matter to older people and their families. This call was underpinned by a concern that an excessive focus on quantitative targets (e.g. the A&E 4 Hour Wait Target) fails to capture important data about care pathways, patient experience and outcomes of care received. These concerns are shared by many other stakeholders. The Health Foundation, for example, has also recommended an overhaul of the current reliance on performance management to improve quality. There is a window of opportunity for influence since Government will be preparing a new Mandate to the NHS for 2016 onwards and the Mandate will be accompanied by new Outcome Frameworks. The BGS will continue to highlight the issues so watch this space!
If you have any comments or questions arising from this article, I would be delighted to hear from you.
BGS Policy Manager
Tel. 02037476940 and
1. Nuffield Trust (June 2015), Health and social care priorities for the Government 2015 – 2020, www.nuffieldtrust.org.uk, accessed online 3 June 2015.
2. Gardner, T. (March 2015), Swimming against the tide? The quality of NHS services during the current parliament, www.health.org.uk, accessed online 5 June 2015.