The government has accepted the recommendations of phase two of the NHS Future Forum, which deal with integration, information, education/training and the role of the NHS in the public’s health.
The recommendations are “robust and ambitious,” said Forum chairman Professor Steve Field. In listening to more than 12,000 people over the second four-month phase, the panel’s members had heard “an enormous amount of support for the shift to patient-centred care but also frustration that this has not yet been achieved. This must now become a reality for patients across England, and health and social care professionals must lead the way,” he said.
The Forum’s recommendations on integration state that: – integration should be defined around the patient, not the system, and that outcomes, incentives and system rules (ie competition and choice) need to be aligned accordingly; – health and wellbeing boards should drive local integration, through a whole-population, strategic approach that addresses their local priorities; and – local commissioners and providers should be given freedom and flexibility to “get on and do,” through flexing payment flows and enabling planning over a longer term.
The government has responded by stating that it “fully accepts” the need to orientate the whole health system around patients. So, for the first time, patient experience of integrated care will be measured as part of the Outcomes Framework, it says.
On information, the Forum calls for: – patients to have access to their online GP-held records by the end of this Parliament; – the NHS to move to using its IT systems to share data about individual patients and service users electronically; and – the government to set a clear deadline within the current Parliament by which all information about clinical outcomes is put in the public domain.
Ministers respond that they will consider the recommendation for making discharge summaries available to GPs and patients at the point of discharge.
Forum recommendations on the role of the NHS in the public’s health say that: – the Service must do more to prevent poor health; – every healthcare professional should use every contact with the public to help them improve their health – “making every contact count” – and this should be a core staff responsibility in the NHS Constitution; and – the NHS must also do more to support the wellbeing of its own staff.
In response, the government says it will consult on a new responsibility for healthcare professionals to promote healthy living through their day-to-day contact with patients.
And on education and training, the Forum says that: – the new local education and training boards must have the governance in place to deliver strong partnerships across healthcare providers, academia and education; – quality must be at the heart of education and training, with systems in place at all levels to reward high-quality education and embed continuing professional development; – a review is needed of the principles and aims of Sir John Tooke’s 2007 inquiry report into modernising medical careers; and – a properly-structured process to support individual nurse and midwife development in post-qualification career pathways should be developed nationally.
Ministers have responded by saying that employers and professionals will have a greater say in developing the health workforce in the future, such as through local plans. And, for the first time, the government will introduce an Outcomes Framework for education and training.
Commenting on the new reports, the Foundation Trust Network welcomed the Forum’s “refreshingly localist stance” on education and training, which “puts employers in the driving seat, by removing overly-rigid national bureaucracy and ensuring greater employer involvement,” said the Network’s chief executive, Sue Slipman.
She also applauded the report’s recognition that “integration is an approach whose time has come. It is in patients’ interests to close hospital services where organisations are inefficient and not viable in favour of supporting others to respond to the increasingly complex needs of patients who require can both in hospital and community settings,” said Ms Slipman.
The NHS Confederation also welcomed these recommendations, but cautioned that if integration is to become the norm, “big issues need to be tackled.”
“We need to be honest that, so far, integration has only been successful as a result of the efforts of unusually determined local leaders who have been prepared to take a lot of risks and swim against the tide,” said Jo Webber, the Confederation’s deputy policy director.
Ms Webber also emphasised that, for the policy of “making every contact count” to finally become real for patients, it will be critical to engage with clinicians more successfully than has been the case in the past.
But Royal College of General Practitioners (RCGP) chair Clare Gerada stressed that it is the patient who comes to the doctor with their agenda “and it is important we do not take over. Every contact should count, in that when the patient leaves the consulting room they must feel that the doctor has listened to them, addressed their needs and was kind,” she said.
