Tomorrow needs to come to the aid of today.

It’s important to plan for the future, but if the NHS and social care are going to survive and thrive then the ideas for tomorrow need to come to the aid of the problems of today.

Within 15 months there will be a general election. It’s very likely that the NHS will be one of the two main issues in that campaign.

I would expect that whoever wins the election will develop a long-term plan for the NHS and social care which will dominate the way in which government works in the domestic policy arena for the next few years.

So for the next few months this blog will try and take a long-term look at the actions that, over the next decade, will change both social care and the NHS.

In looking to that future, a future with more focus on prevention, much more extensive use of technology, much better integration of care, and working within a self-improving system, I will work through how these themes will create the NHS and social care experience of the future.

BUT that much improved future will not arrive unless all these important changes start solving problems today. Unless they have an impact during this winter and the next, the NHS will be in a very bad place indeed in 2 years’ time.

That’s why I restart my blog this October with the slogan that “Tomorrow needs to come to the aid of today”.

Those of us interested in change like to emphasise that important changes take a long time – and whilst that is sometimes true – what if we haven’t got a long time? What if the current crises are so big that we simply don’t have the 5 or 10 years it would take to effect change?

I think that is where we are now. We need all of those good ideas from the future, not just in the future, but today.

Let’s look at prevention. Of course, prevention has to have its biggest impact over a long time. We do need to work with families and schools to improve the food that children eat and the amount of exercise they take. Better health in early years will play a big role in improving the number of healthy years they live in middle age. This is crucial for the health of the nation in 40 years’ time.

But we also need prevention now.

In July this year Age UK pointed out that there are tens of thousands of older people going into hospital that don’t need to. They, the NHS, and social care also need them to have better care in their own homes now. Age UK argue that care needs to keep older people out of hospital not just in 40 years’ time but now.

In 10 years’ time technology will transform the NHS and any plan for the future will need to include the full detail of how that that transformation will work. But we need much better use of technology in the NHS and social care now. In 2023 we need domiciliary care workers able to carry out remote medical monitoring to help people be cared for in their own homes. I hope technology will have made that normal in 10 years’ time but if we are to get through the next two winters we need it happening now.

For over 10 years the NHS has been planning for the integration of health and social care. 10 years ago, the NHS was clear that it wanted to meet “… the challenge of integrating health and social care in England to keep people healthy for longer” (NHSEI 27/10/2013).

But let’s be honest, over the decade that has passed since not a lot of actual integration has taken place. An 80-year-old with 3 long-term conditions in 2023 will still need a spreadsheet to keep track of their appointments with different professionals from health and social care – each looking after different body parts. They will still need to tell their story many times over – rather than the once they asked for via National VNHSIMPACToices in 2016,

In a decade we are promised that Integrated Care Boards (ICBs) will have grasped the integration agenda. Fine, but a few hundred thousand people with multi co-morbidities need that integration today.

It’s true that the NHS and social care need constant attention to improvement. All of the above changes will mean the relationships with patients and their self-care, will need constant attention. This is why the emphasis from the new NHS IMPACT (Improving Patient Care Together) chaired by David Fillingham is so important for the future of the NHS.

But the application of improvement, like all these other interventions,  can’t wait for the future. And whilst I understand how the Health Foundation stresses the importance of time in developing that culture,

It is striking that NHS trusts with the strongest improvement track records have taken 5 years or more to implement their improvement strategy

I’m afraid it’s time we haven’t got. It may take 5 years to develop a full improvement strategy, but we need the interventions that come from improvement now. We need them to help cut long waits and to ensure that the implementation of new technology is a part of today.

Readers will note that I have been arguing for tomorrow’s interventions to take place today in order to ensure that, for example, the domiciliary care workforce can play a fuller role in helping older people get their care at home and not in hospital.

Great at the end of a 10-year NHS and social care plan – but we need it today.

My next two posts will try to suggest that this greater urgency is needed for the implementation of much more training and regulation for NHS leading managers.