2018 will hold much heated exchange about access to general practice and whether video consultations add value to the population as a whole. Enthusiasts will insist this is the future and that we should get used to it. Sceptics will highlight the inequitable diversion of scarce staff and other resources to a healthier-than-average population. The NIHR-funded Alt-Con study will add some hard facts to the debate, but NHS England must commission rigorous analysis of quality and outcomes. The rest of us must continue to persuade newly qualified GPs that the hard yard of list-based general practice for people with complex problems is still worth committing to.
Next year the Government will introduce an Immigration Bill, ending 47 years of free movement of people between Europe and the UK. It will make provisions to allow migrants already here to stay. These must provide security to more than 155,000 NHS and social care staff from the EU, whom we cannot afford to lose. The Bill will also set up a post-Brexit migration system. Given the shortages facing the NHS, this will need to continue to allow thousands of health and social care workers to join the service each year until we train enough people domestically.
Nuffield Trust Health Policy Summit
The beginning of March heralds our tenth annual health policy summit. You can look forward, in person or via our livestream, to 36 hours of debate, networking and challenge on the pressing issues facing health and social care. We will be featuring our work on acute medicine and smaller hospitals, taking a look at patient experience through the lens of clinicians who have experienced serious illness themselves, and considering how we hold on to what is most precious in primary care. Our guest speakers already include Matthew d’Ancona, Nick Timmins, Goran Henriks and Jon Glasby, with more to be announced in the next few months.
April marks the 20th anniversary of the Good Friday Agreement in Northern Ireland. This led to the creation of the Northern Irish Assembly, to which full powers over NHS and social care were devolved. Since then, a series of weighty reports have set out an ambitious vision for transforming care. This year, however, the power-sharing Government as laid out in the agreement collapsed, and talks to create a new one have stalled. We have warned this deadlock is contributing to a failure to address poor performance that has seen one in four patients waiting over a year for an outpatient appointment.
Pay review body
The NHS pay review body (PRB) will be making its recommendations to the Government in April. The Government has told the PRB it is adopting “a more flexible approach to public sector pay, to address areas of skills shortages and in return for improvements to public sector productivity”. There is also a commitment to provide additional funding for staff employed under Agenda for Change in exchange for contract reform. But the PRB need to “consider affordability when making their recommendations”. NHS staff in Scotland can expect a 3 per cent pay rise next year – we await the PRB verdict in England.
We will have to wait until around May to discover in what state NHS trusts will end the 2017/18 financial year. The precise number is unknown, but one thing is absolutely certain: it will be negative. By halfway through the financial year, trusts were collectively overspending at the rate of £346 million a month, once one-off savings and bungs are stripped out of the numbers. That’s the equivalent to every hospital having no reliable income to cover their costs for the last one-and-a-half days of each month. With no sustainable solution in sight, it leaves trusts on track to end 2017/18 with an underlying deficit of £4 billion.
In 2018 we will see the Government put a new infrastructure in place to help the NHS adopt technological, digital and pharmaceutical innovations. This includes transformed Academic Health Science Networks with a bigger change management function, new ‘innovation exchanges’ hoping to support the 15 AHSNs work more collaboratively, and an Accelerated Access Pathway intended to expedite certain innovations entering the NHS. The thing to watch out for though is how far these new bodies will help the NHS move from a product-focused, supply-driven approach to innovation to one that helps the NHS identify its most pressing problems and look for solutions to solve them.
The NHS at 70
On 5 July the NHS will turn 70. This occasion will be marked by a mixture of celebration and soul searching. The celebration will focus on the inspiring things the NHS does every day to improve and save lives, and the soul searching on the phenomenal challenges ahead. The typical NHS patient has changed beyond all recognition since 1948, with medical advances meaning we are living longer but not always in good health. The health service of the future will need to balance expanding patient needs with our insatiable appetite for new drugs and treatments and the reality of fiscal and political constraints. A challenge indeed. Happy birthday NHS!
Next summer, the Government is set to launch its long-awaited green paper on social care for older people. This will be the latest in a long line of consultations and reviews about the thorny issue of social care funding and provision. With the NHS under growing pressure and cuts to local authority budgets biting, there is an increasingly urgent need for agreement on a sustainable system of social care for our ageing population that works alongside health care. For proposals to gain traction, it will be essential that the Government garners genuine cross-party support, stakeholder endorsement and, crucially, public buy-in.
Proposals to develop different types of accountable care organisations (ACOs) or systems (ACSs) form an important part of local plans for the future of the NHS. Eight regions in England are set to evolve into ACSs during 2018, but many practical aspects of making these systems work are challenging. The legal challenges ACOs currently face are premised on the mistaken notion that they represent privatisation, with a more significant and unanswered question being how, without the competitive forces that shape ACOs in the USA, do we avoid creating cosy geographical monopolies that favour member organisations rather than focusing on patient preferences and population outcomes.
Quality and Outcomes Framework
NHS England is ‘committed in principle’ to scrapping the Quality and Outcomes Framework for GP practices, but it’s still unclear what alternative might be put in place. There is a lot at stake here. Many practices view funding via QOF part of their ‘core’ income, yet evidence shows it hasn’t really achieved the improvements in care it set out to. There may be benefits to a ‘retained but reformed’ version of QOF, but the downside of this approach is that we may miss the window of opportunity to do something better, both for GP practices and for patients.
Winter A&E targets
The Government’s mandate to NHS England for 2017/18 set a key deliverable that, by March 2018, at least 95 per cent of people attending A&E must be seen within four hours in the majority of trusts. In November this year, 126 out of 137 major A&E departments missed the four-hour target, and this number is expected to rise over the winter as in previous years. This raises the question whether the extra £335 million for winter pressures announced in the Autumn Budget is enough for NHS England to meet the A&E performance objectives, or whether it’s too little too late.
Nuffield Trust (2017) “2018: What to look out for in health and social care”, Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/2018-what-to-look-out-for-in-health-and-social-care