The incoming Labour government has called for a 'revolution in prevention'. John Copps looks at what this means for healthcare services and beyond.
After sweeping to power on 4 July, the new Labour government seem to have hit-the-ground-running. Health secretary Wes Streeting has been particularly vocal about his ambitions.
In healthcare, there’s lots marked ‘urgent’ in the in-tray – including resolving the junior doctor pay dispute and beginning to tackle hospital waiting lists – but if there’s one word that sums up the goverment's long term strategy for healthcare it is ‘prevention’.
This is part of the government's stated fifth mission to 'build an NHS fit for the future'. The manifesto was explicit on where this must focus: 'Labour’s reforms will shift our NHS away from a model geared towards late diagnosis and treatment, to a model where more services are delivered in local communities... And we will embed a greater focus on prevention throughout the entire healthcare system and supporting services.'
During the campaign, there was talk of a 'revolution in prevention'. For Streeting, this is about shifting investment upstream, more care in the community, and a laser focus on public health. All that aims to rebalance the system and take the pressure off expensive acute services.
In some ways, we have been here before. The 2019 NHS Long Term plan called for a redistribution of resource aways from acute to primary and community care services - but, instead, the proportion of the NHS budget spent on hospitals has grown since then.
So what levers might the new government pull to create change? How will this rebalancing be achieved and what can we expect? Here are three things we know:
More investment in Primary Care
Primary Care is rightly identified as critical to a preventative approach. Laying down a marker, Wes Streeting's first visit as health secretary was to a GP practice and it has pledged to train 'thousands' more GPs. He also seems to recognise the importance of the relational aspect of care, in terms of the individual patient-doctor relationship. The government's election manifesto commits to 'incentivising GPs to see the same patient, so ongoing or complex conditions are dealt with effectively'. How it will do this is not explained though.
But primary care is not just about General Practice. The government want to take pressure off GP surgeries by creating a 'community pharmacist prescribing service' and allow other routes into specialist care. Investment in dentristry features prominently. Whilst these ideas are not new, they have arguably never been implemented in a determined way.
Valuing community and mental health services
Improving mental health services was another key commitment in the election manifesto - with a pledge for better children's and adult services. New 'Young Futures Hubs' are promised provide open access mental health services for children and young people in a community setting. Alongside this, the government says it will recruit 6,500 more mental health staff over its five-year term.
Closer integration of services at a community level is badged as an enabler of better care. The Health Secretary has promised to trial 'Neighbourhood Health Centres', bringing together existing services such as family doctors, district nurses, care workers, physiotherapists, palliative care, and mental health specialists under one roof - and out of the hospital.
Greater focus on the wider determinants of health
Action on public health will include a bill announced in the King's Speech to ensure the next generation can never legally buy cigarettes - a remnant policy of the previous adminstration. Obsesity, gambling-related harm and online are also in the cross hairs. Plus there are practical plans for children's health improvement with supervised tooth-brushing schemes and free breakfasts at school.
Outcomes are pitched in terms of reducing inequalities and a pledge to halve the gap in healthy life expectancy between the richest and poorest regions in England. Place leaders are set to be given greater powers in their area over the economy, planning and many of the other factors that play into the wider determinants of health. One of the first actions of the Prime Minister was to meet with the cohort of metro-Mayors
In asserting the centrality of prevention to 'build an NHS fit for the future', the new government has made a promising start. But, as recent history atests, it is easier said than done. Rebalancing the system will not be easy and needs long term, sustained commitment. The ambition is there but it will take years before we know whether it has worked - and whether it can match the reality with the rhetoric.
To read more on MV's work in healthcare and prevention click here.
To catch up on the latest from our Prioritisiting Public Services work click here.
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