Nuffield Trust response to 10 Year Health Plan details on neighbourhood teams, dentistry and technology

On the announcement in the 10 Year Health Plan about rolling out neighbourhood health teams, Nuffield Trust Chief Executive Thea Stein said:

“Today’s announcement is about expanding and embedding what’s happening already in many places in the NHS. Top quality community services – like district nursing, end of life care and rehabilitation – are, in pockets of the country, already working around the clock to fit care around patients' needs, working closely with GPs, charities and council staff.

"This approach is essential if we want to end the disjointed ways of working that too often leave patients to do the time-consuming and often bewildering job of joining up their own care. So any attempt to support, develop and spread this approach is welcome, especially as this work is often underfunded and overlooked.

“But simply saying that the approach will be rolled out, without full details on how to bring it about, casts doubt on whether it will stick. This is hard, complex work, requiring leadership from politicians and NHS staff alike to challenge cultures and power dynamics, and create new ways to route money through the system so it doesn’t get sucked into the pressing and often urgent needs of other parts of the health service. It is these dynamics, rather than a lack of imagination or belief, that has meant that neighbourhood care has failed to become more than a few passion projects, like the Derby example cited by ministers.

“What’s more, care closer to home doesn’t mean care on the cheap. While ministers are always keen to cite examples of community services saving money, often this kind of care costs more, not less, as the economies of scale that might have been realised in hospital are difficult to achieve in communities. Better community services is the right aspiration – siloed care is often frustrating and distressing for patients and contributes to waste. But let’s be under no illusion: this is not a money saving measure.”

On the measures relating to dentistry, Nuffield Trust Director of Research and Policy Dr Becks Fisher said: 

“Our failure to get dentists working in the NHS is at the heart of why a comprehensive service has collapsed. The government is right to think about how to address that, and how to make use of a wider range of staff.

“But a three-year work requirement for new dentists isn’t a full or simple solution. NHS rates are simply not competitive with the private sector in many areas. While this remains the case, it’s all very well to force dentists to do three years’ work for the health service, but they will still tend to simply drift away afterwards. What we need is a proper reform of a dental contract which successive governments have seen as unfit for purpose for more than 15 years.

“Making more use of other staff like dental therapists is an excellent idea. But the recent NHS history with roles such as physician associates, which caused confusion and backlash, shows that this needs to be handled very carefully. There must be plenty of time for roll-out, a proper understanding from the start of the role and its limits, and regular monitoring.”

On the commitment to a “digital-first” NHS, Dr Fisher said:

“A better-connected digital NHS could address some of what patients find most difficult about health care: having to repeat themselves to different professionals, facing a confusing mess of phone lines and apps between different parts of the service. The risk is that some patients, without the money for data on their phones, or the skills to use the system, will be left behind. The NHS will always need to have a real front door too for those who need it most.

“Accessing clinicians digitally also carries the risk something will be missed that could have been spotted face to face: getting this right is difficult but crucial.

“The health service’s history shows that new technology often costs money, rather than saving it. This doesn’t mean it is the wrong thing to do, but balancing sums based on the assumption of big savings would be asking for trouble.”