Increasing Public Involvement in NHS Long-term Planning – 2

Yesterday I made the case for starting the development of a new NHS plan with discussions for better prevention with the main charities that work with major disease groups. This is a vital starting point for any recreation of a contract with the public.

But this relationship with the public is not owned by such groups alone. To even touch the sides of a task as epic as creating a new relationship between the NHS and its public, will need much greater public involvement in its planning. Over the next few weeks there will be many different posts on this topic. Today I want to talk through what might be the conversation with the group that represents the high users of the expensive end of the NHS – the frail elderly.

I think the best starting point here is a quote from a plan that didn’t happen.

The 2019 Long-term Plan did however provide a clear direction:

“1.2. The long-standing aim has been to prevent as much illness as possible. Then illness which cannot be prevented should wherever possible be treated in the community and in primary care. If care is required at hospital, its goal is treatment without having to stay as an inpatient wherever possible. And when people no longer need to be in a hospital bed, they should then receive good health and social care support from home.

        • Prevent if you possibly can.
        • If not treat in the community
        • If you have to go to hospital, only go as an outpatient.
        • If you have to be an inpatient get out as quickly as possible into your own home.”

But since this long-term plan the hasn’t happened. How will a new 2024/5 10-year plan make any difference to the reality of practice?

I suggested yesterday that most of the big patient disease charities would now agree with this direction of health care policy and practice. In the past the NHS was frightened of involving patients since they were worried that all of them wanted to go to hospital and would resist a move to better prevention and out of hospital care. As I claimed yesterday – if that was ever the case patients’ organisations are signalling a change.

But I think this goes beyond interest groups to include major public organisations. And one of the most significant charities in the UK is Age UK.

In July 2023 Age UK, in its annual state of health and care report, argued strongly that too many old people were spending too much of their lives in A&E and in emergency beds in hospitals. They made a strong case that this was bad for them and that older people would be better served by better health and social care at home.

“But it doesn’t have to be like this. Instead, we could respond to the evidence in this and other reports and change how we are supporting our older population, with a much greater chance of success. There’s no escaping the need for us as a country to spend more on the NHS and even more so on social care but, just as importantly, we need to spend it differently.

Specifically, we should:

        • Reverse the decline of primary and community health services and social care so more older people get more help, earlier, enabling them to stay well for longer at home and reducing their reliance on crisis care in hospitals.
        • Join these community-based services up so they are genuinely multi-disciplinary, include the voluntary sector, and work closely with GPs and their staff.
        • Establish a fundamental principle of ‘home first’ to our approach to care. Rather than older people always having to go to hospital it will often make more sense for the hospital to come to them via hospital at home teams and virtual wards. We need more preventive services too, such as those which tackle the risk of falls.T

These and other approaches are already becoming part of the mix in some communities, we simply need many more, everywhere.” (Page 15)

The fact that the major organisation representing us older people now want such a clear policy direction is of great significance. And of course, they are right. As this blogger has said on many occasions (and experienced for a week as an inpatient last year) at 75 ten days in a hospital bed endangers the loss of about half your muscle strength. That makes independent living very difficult.

So, as the 2024/5 NHS and Social Care Plan is developed, the involvement of Age UK in the detail of both its policy and probably implementation will be essential.  They will know – better than policy makers – how to allay the anxiety of the frail elderly that such a policy direction would in some way deny their care. It won’t – but they might have a much better chance of getting health care that fosters their independence rather than undermines it,

In much of my 20 years working with the NHS, too many people have claimed that the reason they can’t spend more on prevention, or move more care out of hospitals, is because the public won’t let them. (I think what is really meant by that is this change in practice would be really difficult “so isn’t it great we don’t have to do because the public don’t want it.”)

Well, that’s no longer the case. If we want to increase care in the community for the frail elderly, let’s get Age UK actively involved from the very beginning. Let’s work with them and the people they represent to provide much better care for older people.

…and yes, whilst we are doing so, save the NHS.

Organisations such as Age UK – if they and their members put in the time and effort to help us construct an NHS and Social Care Plan – will expect us to actually do it. They will not accept the suggestion that because hospitals have gained the greater share of new resource for the last few decades, that this must be the case in the next two. They will demand change and together that gives us a much better chance of making it happen.