The NHS is 'fragmented and not yet currently configured to optimise the management of complex, long-term conditions,' a report published this week finds.
The Hewitt Review, written by former health secretary Patricia Hewitt examined Integrated Care Systems (ICSs) in England, focusing on the NHS targets and priorities for which Integrated Care Boards (ICBs) are accountable.
She recommends that current ICB targets be replaced by no more than 10 national priorities and that local leaders be given more space and time to deliver improvements in services. She concluded that setting new targets and failing to provide adequate funding for new initiatives makes it far harder to plan new services and recruit staff.
Hewitt also said that hospitals will never be large or efficient enough to cope with the growing demands by an ageing and increasingly unhealthy population, and pointed to the positive role of community health services.
Preventative model of care
She highlights the importance of shifting towards a preventative model of care to improve healthy life expectancy and to avoid hospital admissions in the first place – calling for the share of total NHS budgets going towards preventative care to increase over the next five years.
The Hewitt Review outlines three main reasons for needing a new approach for the health and care system:
- immediate pressures upon the NHS and social care including access to primary care, urgent and emergency care, cancer, other ‘elective’ care, and mental health services
- growing number of people living with complex, long-term physical and mental health conditions, often associated with serious disabilities or ageing
- as a nation our health is getting worse - more people spend longer in ill-health and die too young, particularly the least economically advantaged and those most affected by racism, discrimination, and prejudice.
Widen range of stakeholders
An important step forward for AHPs working in primary care, if accepted by the government, is the recommendation to develop a new framework for GP primary care contracts, widening the range of stakeholders involved. It is essential that organisations such as the CSP representing non-medics in primary care multidisciplinary teams are included as key stakeholders.
Sara Hazzard, CSP assistant director of strategic communication said: 'We welcome the focus on the impact of long-term conditions on health, wellbeing and the economy, and the importance of shifting towards a preventative model of care. It was particularly positive to see the key role of community health services highlighted.
It was disappointing to see the missed opportunity to include rehabilitation as key to prevention and we would therefore urge the government to include rehab as it considers the reports’ recommendations.
'The review also acknowledges the growing inequity in access to healthcare and, as our recent Easing the Pain report highlighted it is essential that ICSs have a leadership role in tackling disparities in health life expectancy.
Rehab leads in every ICS
'This is why we are calling on the government to implement single accountable rehab leads in every ICS.
'It is clear that many of the recommendations require a fully funded workforce plan which clearly sets out how it will recruit and retain the big increase in physio numbers we need in the NHS to enable patients to get the quality of care they need to live as well as possible.'
The government is now considering the report’s recommendations.
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