In her latest blog Lisa Taylor, Health and Wellbeing Programme Director, VONNE, reflects on the themes of this year's NHS Confed Expo conference. She explores the three key shifts within the NHS 10 year plan and the VCSE sector’s role within that; the future of system-wide partnerships, collaboration and Alliances; addressing health inequalities; how patient voice and community insight can be fully integrated into the new systems; and the vision for the future of health and care.
Attending the NHS Confed Expo this year was a very different experience to last year. There was a strong emphasis on partnership working, with the Voluntary Community and Social Enterprise (VCSE) sector being named as a key partner within health systems at least a dozen times by mid-afternoon on the first day.
Innovation was also high on the agenda, with the key shift from analogue to digital being a prime opportunity for the NHS to “move with the times” and utilise a host of new technologies, including AI and genomics, to improve patient and staff experience, support predictive and preventative treatment and help streamline processes.
The other two shifts within the NHS 10 year plan - hospital to community, and treatment to prevention - also featured during the conference, and are areas in which the VCSE sector leads the way. This is where we operate, these are the places in which we can provide key strategic insight to support full transformation across systems and localities. There was not a lot of explicit mention of the VCSE sector in relation to these shifts, however there were many examples of how working with the VCSE sector has improved health and wellbeing outcomes as part of a multidisciplinary approach.
I noticed a lot of rhetoric about partnerships, and some fantastic examples of where things have worked incredibly well in systems where there is a strong and more equitable relationship between the VCSE sector and Integrated Care Boards (ICBs), but came away with no clear sense of how to ensure the VCSE sector is embedded within new systems, or how this would be funded. Each Integrated Care System (ICS) currently has a VCSE Alliance, which brings together the VCSE sector across the ICS footprint. In the North East and North Cumbria this is the VCSE Partnership Programme, hosted by VONNE. These alliances carry out invaluable work, including convening the sector and providing vital connectivity between the NHS and the VCSE. Alliances also support inclusion of the insight and intelligence of the VCSE sector from place right up to board level within strategic planning, ensuring the voices of people and communities are able to be at the heart of ICB plans.
Alliance42 is a group consisting of the leads from all 42 VCSE alliances, and a group member asked a question of Jim Mackey, CEO of NHS England, about how to ensure VCSE alliances are embedded within systems going forward, as it had been stated that there will not be a national mandate regarding who the NHS should include in partnerships in the new iteration of ICBs. Alliance42 feels that this leaves the door open for the expulsion of the VCSE sector as strategic partner, which would have a hugely negative impact upon ICBs and their populations. Mr Mackey requested to pick up the conversation offline, and a meeting is currently being set up to explore the subject further, which feels like a positive development.
However, the concern remains that there is no clear vision of what any sort of “real life” input into ICBs will look like in the future, and continuing developments and announcements – including the abolition of Healthwatch - indicate that this is an area where there will need to be a huge amount of effort from all sides to ensure patient voice and community insight is fully integrated into the new systems. The NHS will fail in its aim to serve communities if it is not able to communicate with and listen to them.
Throughout the conference, there was a sense of increased awareness that tackling health inequalities is going to play a bigger part in the national plan. This was cemented by the subsequent announcement that funding is going to be targeted more towards areas experiencing the largest inequalities. But with policies like the child benefit cap in place which disproportionately affects the poorest families, it remains to be seen whether the individual elements that seem to oppose each other will lead to a more positive longer term overall outcome.
Wes Streeting, the Secretary of State for Health and Social Care, shared some key recent achievements and plans – the national waiting list fell for the first time in 17 years in April, there is an aim to have mental health support in every school, and the highest ever capital investment for the NHS is now happening. He also commented on the three key shifts, noting that lots of services traditionally delivered in hospital would be delivered on the high street and that the next 10 years will be “a decade of renewal, building an NHS fit for tomorrow.” There was a clear articulation of priorities, including the NHS having a clear purpose, underperformance being tightly managed, and changes to finance procedures supporting positive change, including incentivised outcome targets. It was also hammered home that the NHS had done well in the spending review, comparatively. Diversity was also raised as an important point – the NHS was built upon immigration, it would collapse if all its migrant workers left, it is an international workforce and always will be. Due to the 10 year plan not being published until after the NHS Confed Expo, there was a limit to how much could be articulated about the “how” of delivery of future plans, with the promise that things would become clearer once the plan was in the public domain.
There was an additional hint of things to come from Jim Mackey, with strong language used in references to an avoidance of centralisation, a breaking down of complex decision-making processes, a focus on outcomes and not outputs, the tearing up of duplication, and greater Foundation Trust responsibility.
“Fixing a broken NHS” is a neat catchphrase, but it doesn’t feel particularly helpful or fair, especially to the staff who work so hard within our health service to provide care to our population. Even so, there is no denying that the systems we have in place currently are not working the way they should for everyone. However, there appears to be a dangerous incoherence within national policy planning. Removing morals and ethics from the equation, the proposal to cut benefits for disabled people, pushing hundreds of thousands of men, women and children into poverty, did not take into account the increased pressure and associated cost implication on other areas of the public sector. There was no consideration for the disabled people who may not experience poverty immediately, but would not be able to carry out “activities of daily living,” forcing many out of paid employment and into reliance on an already saturated social care system - not to mention the additional pressure their increased health needs would place on the NHS. Viewed alongside the separate, significant government investment into tackling health-based causes of economic activity, it seems contradictory. Actively increasing the amount of people experiencing health inequalities while simultaneously providing funding to address health inequalities seems like a cruel seesaw that won’t benefit anyone in the long term. But if the three key shifts for the NHS are carried out in conjunction with other areas of policy, they do have the potential to improve the current situation.
The NHS can’t be “fixed” without addressing the multitude of contributing societal and economic issues, but what I took away from Confed from speakers and participants alike, and what I take from my work as a VCSE Alliance lead, is that there is huge will across all parts of our multi-sectoral health system to make things better by working better with each other, and the will of good people should never be underestimated.
Lisa Taylor, Health and Wellbeing Programme Director, VONNE, North East and North Cumbria VCSE Partnership Programme lead and North East and North Cumbria ICB VCSE representative.
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