Javid puts prevention at heart of reform plan

In a speech to the Royal College of Physicians on Tuesday, the health and social care secretary (pictured)  said the NHS faced three long-term challenges. Demographics and diseases are changing; people’s expectations have been raised as a result of technological advances; and the service also faced unsustainable finances.

These were challenges before the pandemic, but Covid-19 had accelerated the need to choose between ‘endlessly putting in more and more money’ or reforming healthcare. ‘I choose reform,’ he said.

He argued reform is already underway with the move to integrated care systems across England. And he also pointed to white papers on adult social care reform and integration and the recently published elective recovery delivery plan. New measures on prevention, personalisation and performance would now build on these foundations.

The ‘new mode of operating’ would be about helping the whole population to stay healthy, not just treating those that show up asking for help. The NHS had ‘huge reach’ and a ‘huge budget’, but had been consistently under-utilised in prevention. ‘That must change,’ he said. ‘We must hardwire prevention into the NHS.’

The road to recovery would start with tackling the Covid backlog with a target that 99% of people will be waiting less than a year for treatment by March 2024. But he said it was just as important to stop new people joining waiting lists by supporting them before they get ill.

‘Not only do we need to put the power of every part of the NHS behind prevention – we also need to put the power of the NHS budget behind it too,‘ he said. ‘It’s self-evident we need to increase spending on prevention, yet we don't accurately know how much we spend.’ A baselining exercise will be undertaken as a first step towards agreeing how much investment in prevention will increase year-on-year.

Prevention will also be at the heart of how ICSs are held to account. Systems will be expected to develop plans to reduce cardiovascular disease in the first instance, but this approach will expand in future to diabetes, cancer and poor mental health. The NHS app will also be developed to promote prevention.

Personalisation could improve care for people with multiple conditions. Instead of focusing on individual diseases, the service should concentrate on the person as a whole. And care was often fragmented across a range of providers, specialists and sectors instead of being part of a longer-term plan for their overall health.

Mr Javid set a new target for four million people to benefit from personalised care by March 2024, extending the current target of 2.5 million, which he said had been delivered two years early. There will also be a ‘significant expansion in personal health budgets.

A new right to choose will also see long waiters offered alternative options for treatment – in a neighbouring trust or the independent sector, for example. While this was already a feature of the best systems, Mr Javid said it would become standard across the NHS. People at risk of waiting 78 weeks will be contacted by the end of December with an offer of alternative provider options, with those waiting over two years contacted by the end of this month.

Mr Javid insisted this choice would be available to everyone, not just the privileged few.

On performance, Mr Javid said there would be a focus on areas where the NHS could do better, such as cancer survival, cardiovascular disease and maternal health outcomes. A 10-year cancer plan will be published later this year.

Behind the three Ps of prevention, personalisation and performance was a fourth P – people. And Mr Javid said that a bigger workforce was essential. While he said there were 41,000 more NHS workers than this time last year, including 11,000 more nurses and 4,000 more doctors, he promised a ‘proper long-term workforce plan’.

Matthew Taylor (pictured), chief executive of the NHS Confederation, welcomed many of the initiatives in the health secretary’s speech, including plans to harness digital technology and personalised medicine. ‘But new ideas alone won’t be able to magic up new staff, and that remains our single biggest constraint,’ he said. ‘The sooner we get a fully costed and funded workforce strategy the better.’

He also flagged some concerns about the new measures on choice, with the restriction to those waiting the longest risking a widening of health disparities. ‘We understand the desire to end the longest waiting times, but this needs to be balanced with treating those patients with the greatest clinical need. They won’t always be the patients who have waited the longest,’ he said.  

Mr Taylor added that the NHS had shown what could be achieved over the last two years when the service is supported. But the NHS faced a once-in-a-generation challenge with the size of the care backlog, major pressure on emergency care services, staff shortages of over 110,000 and widening health inequalities. ‘That’s why the ambitions of political leaders must be firmly grounded in the intense operational reality that NHS staff find themselves in every day of the week,’ he said.