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In this blog Charlotte Augst reviews the 'Next Steps on the the NHS Five Year Forward View' and suggests we need to mainstream better ways of supporting people living with long term conditions.

A difficult job

Setting out credible next steps for the NHS in the current economic and political climate was never going to be easy.  Holding on to a vision in which targets can be hit and budgets balanced, on the back of fundamental changes in the design and delivery of care is doubly difficult.

So it is no mean feat that ‘Next steps on the 5YFV’ manages to outline some credible actions that will take us closer to a world in which primary and community care step up, where mental health gets the attention it deserves, and where all the disparate organisations, boards and plans running a place come together and improve the health of their people.

This direction of travel is right for the majority users of health and care: the many millions of people living with at least one, and often more, long term health condition. The Richmond Group of Charities supports the ambition that runs through this plan. Less siloed working and more collaboration will create the best chance of the limited money available reaching the people who need it most.

Made more difficult

However, the plan is curiously silent about the need for a different kind of integration: Integration that isn’t just about merging overstretched services and exhausted budget lines, but which starts with people and their needs.

Ultimately, pressures on services will only be sustainably reduced if people are supported to live healthier, happier lives. When illness strikes, a helping hand with the non-medical issues, such as work, housing, loneliness or low mood, can be just as important as the medical care we receive. Attention to these issues can also help us stay healthy and prevent illness. However, these, factors, which the health system calls “the wider determinants of health”, and the rest of us call “everyday life”, remain a blind spot for our current NHS. 

Integration isn’t just about merging overstretched services and exhausted budget lines, it must start with people and their needs.

Fortunately, patient, care and volunteering charities all have substantial experience of supporting people with long -term conditions in a way that works both for people and for the health system.  Our work involves having a different kind of conversation with people: starting with their own goals and, together, finding ways of overcoming obstacles to achieving them, drawing on individuals’ own strengths and those of their families and communities. We have done the hard work of researching, piloting and evaluating such approaches.  So it is frankly disappointing that last week’s Plan says nothing concrete about mainstreaming this kind of support.

Making it work

The document makes some welcome (but unspecific) statements of intent around social prescribing, self care, carers support and a group of STPs that will develop strong partnerships with their local VCS. But it’s not clear how any of this will happen. A bolder plan would have set out a route-map for mainstreaming person-centred integration and prevention through new care models and primary care.

The move towards ‘accountable care systems’ (ACS) will hopefully give the system space to focus on the outcomes that really matter. But for this to work we must put people at their heart. It is therefore worrying that there is no requirement on these systems to show how they will provide more holistic care for people who live with long term conditions, nor to build meaningful partnerships between the health system and local VCS.

Charities’ ability to build relationships that stand outside the statutory hierarchies, our understanding of people’s medical and non-medical needs, and our access to volunteers and networks of progressive professionals, all are important success factors for a transition to place-based health and care.

Better together

So in our view, the welcome, but somewhat disparate commitments contained in this plan need to be turned into an impactful strategy. In order to do this, we need to:

  • Mainstream fully enhanced primary care: Roll out models of care and support planning, social prescribing, and the coordination of medical and non medical support, which bring the wider community, through the VCS, into the heart of primary care.
  • Put people at the heart of ACSs: Require meaningful partnership between ACSs (and other integration initiatives), and their local VCS so that their insight, practice and advocacy can effectively shape care for people with long-term conditions.
  • Provide effective support at home: Ensure that the extra social care funding helps to connect people and their carers with responsive and holistic community-led support
  • A new deal for long term conditions: Drive collaboration across sectors by bringing together voluntary, community and statutory sector partners in a new task force to turn the disparate commitments in the Plan into a coherent programme which transforms the experience of people with long-term conditions.

We stand ready to help with all this work. We are better together.