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NNHSA Position Statement – Next Steps

April 11, 2017

There is plenty to welcome in the announcement, including action to improve cancer care, extra money for children’s mental health and more NHS walk-in centres.

A realistic plan, but contradictions remain and people will still suffer

  • We applaud Simon Stevens for being up front about the trade-offs that will have to be made. Non-the-less, dropping the waiting targets means people will have to wait longer in pain and people starting to die on waiting lists. This is a retrograde step for British citizens and one that is quite unnecessary – if the health service was properly funded.
  • The glaring hole at the centre of this Delivery Plan is the lack of additional money.
  • It’s not clear how getting hospitals to provide advice on smoking and drinking sits alongside the cuts to public health
  • Encouraging more people to go into nursing is to be applauded but it is not clear how that sits with the Government’s decision to axe nursing bursaries.

STPs, CCGs, HWBs

  • The government needs to come clean on how it sees the future of CCGs and Health and Wellbeing Boards? Will the rise of the place-based STP render CCGs and HWBs irrelevant?

Now we need rapid action on health creation

  • We are very pleased that the Plan exhorts STPs to ‘mobilise collective action on “health creation” and service redesign’.
  • However, the difference between aspiration and reality is a yawning gap!
  • We now need to see another delivery plan setting out steps that NHS England, Public Health England, Department of Health and Health Education England intend to take to refocus the NHS and wider health system on ‘wellness’ and health creation, alongside an upgrade in prevention.

General practice

  • New NHS Alliance wants to see health creating practice supported through the GP contract and other primary care contracts. For example, the Patient Participation Group Direct Enhanced Service could be reworked; a Direct/Local Enhanced Service could be introduced to harness the power of local people.
  • All staff need to be trained in health coaching and actively promote self-management as part of a health creating curriculum, in order to decrease dependency on the system.
  • Why do GP federations need to be formalised into hubs?
  • There are questions on how, when there is already a shortage of GPs and they are being asked to provide a seven-day service, they will also be on hand to help in A&E units.

Pharmacy

Mental health

  • While we are glad that mental health receives particular attention, we continue to see a purely service approach whereby access to dedicated services is prioritised. We would like recognition that Health Creation has a significant role to play in improving people’s mental state and that embedding health creating (salutogenic) practices across the health system can make a significant difference to the general state of people’s mental health.

Housing

  • We’re surprised that the interface between medical institutions and people’s home environments – the place where patients spend the majority of their time – does not receive greater attention.
  • If we are to shift to a home-based, community-based health system we need to start talking routinely about what’s happening in those homes and communities and which organisations might be best placed to support it.
  • This Housingforhealth resource shows the breadth of what’s possible when housing and health work together.

Work and health

  • We are interested in seeing more about the programmes to support healthy communities and support disabled people and those with long-term conditions to manage their own health, care and wellbeing.
  • At a recent New NHS Alliance event, we concluded that strength-based (health creating) approaches – that focus on what people can do, rather than on their illness – can help to keep people active and in work despite health-limiting conditions.