Earlier this week Jeremy Hunt addressed the NHS Confederation Conference in Liverpool and took the opportunity to set a deadline to ‘solve’ the A&E crisis that has so dominated the news agenda for the last few weeks.
The Health Secretary told the Conference that he has given NHS officials 10 months to draw up a plan to help those with chronic conditions, currently the heaviest users of the NHS. Mr Hunt told delegates: “We are putting together a strategy focusing on the group of people who if we help, we can also do the most to relieve the pressure on A&E. That is vulnerable older people, the people who are heaviest users of the NHS, people with multiple long-term conditions. We are putting together a vulnerable older people’s plan with three elements, and we would welcome your input to that plan, which we hope to conclude by the autumn and implement from April next year.”
So far so good, and the fact that it coincides with the current review of emergency and urgent care being carried out by Professor Sir Bruce Keogh is helpful in that it shows more joined-up thinking than had previously been the case. It remains to be seen however whether many of the key stakeholders in such a plan will be able or willing to implement it in the timescale specified. GPs are still furious with Mr Hunt for his suggestion that their 2004 pay settlement and relaxation of out of hours requirements were to blame for much of the crisis affecting A&E departments, whilst Labour has recently broken the fragile cross-party consensus on the Dilnot care cap and argued that cuts to the primary care budgets initiated by the Coalition have effectively triggered the A&E crisis by reducing the community care capacity.
Most commentators would suggest that the travails of the NHS are not solely due to one thing or another, but a combination of many things, including the botched introduction of the 111 service but even more importantly the remorseless ageing of the UK’s population and the proportion of people living longer but in ill-health. 10 months will probably not be enough time to start making real change to the volumes at A&E and when 100 year-old pensioners like Lydia Spilner are left to die from dehydration in our hospitals, you realise that there is still such a long way to go to get even the basis of care right, let alone a complete re-organisation of health and social care integration.
For change to be effective, there has first to be an acceptance that change is needed. Some have argued that the NHS should act more like a business whose customer base has changed, and reconfigure services accordingly. Certainly the traditional models of delivery are starting to break down, and if Mr Hunt can unite the disparate groups that make up our modern health and social care system and somehow get them to agree there is a problem, and that there is a common ownership of the problem, then he will have made significant progress. Plans are all well and good, but to be realistic they need to involve people and there are still too many siren voices opposing this latest initiative. The axiom, ‘Success has many fathers, Failure is an orphan’ was never more true than when looking at healthcare.