NHS listening exercise: patients have their say

Age UK is co- hosting a listening event on Thursday 19th May to enable older patients to put their views to Government on NHS modernisation and the Health and Social Care Bill.

At the beginning of April the Coalition Government announced that it would be ‘pausing’ progress of the Health and Social Care Bill to embark on a listening exercise. Since then NHS reform has been on hold awaiting the recommendations of the Future Forum, a group appointed by Government to review their proposals and make recommendations to improve the legislation. Members of the Future Forum and Ministers have spent much of the last 6 weeks travelling the country listening to people’s concerns. This week it’s the turn of service users and carers to make their voices heard. On Thursday Age UK will co-host an event with ten other leading health charities giving Minsters and Future Forum members the opportunity to hear directly from older patients about their views on NHS reform.

The NHS is one of the most prized institutions in Britain today – and for very good reason. For nearly 65 years the NHS has delivered comprehensive healthcare, essentially free at the point of delivery, to anyone in need. While both science and society have changed enormously since 1948 – and with it our expectations and aspirations – these core principles remain hugely important to the British public. The Health and Social Care Bill represents the most fundamental reorganisation of the NHS since it started. It is hardly surprising then that the proposals have sparked huge public debate.

As the debate around reform has intensified it has become increasingly focused on one issue in particular; whether reform is necessary to make sure the NHS is equipped to meet the needs of a growing older population. And, if so, whether this particular package of reform is the right one? 

The case for change is compelling. The NHS does not deliver the best treatment outcomes for older people, lagging behind other EU countries in successful treatment of cancer, stroke and heart disease for example. Nor does it always provide good quality care or safeguard people’s dignity. The Health Ombudsman report ‘Care and Compassion’ was a shocking indictment of the poor care some older people are subjected to. We urgently need to see a real change in the way that the NHS views and treats people in later life.

The NHS also has a poor track record of providing joined-up care, personalised to meet patients’ needs or respect their preferences. The failure to successfully integrate services and coordinate care has a huge impact on people in later life, many of whom live with multiple long term conditions, co-morbidities and have cross-cutting health and social care needs. We need a fundamental change in the patient journey placing much greater emphasis on holistic care

The NHS is often poorly equipped to meet the needs of people in later life. It continues to under-commission vital community and preventive services used mainly by people in later life, such foot care, falls prevention and continence care. There is evidence that older people face discrimination in accessing mainstream services as well, for example mental health services. Commissioning is currently failing to reflect the reality of the NHS’ largest patient group. There needs to be a complete review of how the NHS assesses, prioritises and commissions services to meet the needs of an ageing population.

Although we have seen improvement in the NHS over recent years and some good practice emerge, progress overall has been patchy. Reform is required to meet the needs of a growing older population and provide the kind of high-quality holistic services people in later life want, without huge increases in funding we know aren’t going to be available.

This then begs the second question: whether the Health and Social Care Bill will deliver the improvements we sorely need? On this point we have a number of reservations.

The overall vision for health set out by NHS White Paper ‘Equity and Excellence’ is one Age UK largely supports. Holding the NHS to account for the actual results that it achieves in terms of treatment outcomes and patient experience is a positive step. Giving a much strong role to public health and prevention is equally welcome. For too long the NHS has delivered a ‘national sickness service’ without a coordinated strategy for tackling the root causes of poor health and inequality. Drawing together the NHS, public health and social care into Health and Wellbeing Boards to improve coordination and integration has the potential to make a real difference as well.

Alongside greater local accountability for the NHS, the White Paper also promised a step-change in patient and public involvement. Promising patients much greater choice and control over their own care and services users a real say in how their services are run. ‘No decision about me without me’ should be fundamental to all health and care services.

However, the Health and Social Care Bill as it stands risks falling short of this vision. Age UK has been calling on Government to make changes in five important areas:

  • Delivering better outcomes for older people. The Government’s outcome framework sets out key areas where the NHS will have to demonstrate that it has made improvement, as for example cancer care. We want to make sure that commissioners are required to focus on the whole population, including hard-to-reach groups of older people, by setting a clear duty in the Bill for GP commissioners and the NHS Commissioning Board to show how it has worked to improve care for all groups of patients.
  • Better public and patient engagement. Despite the rhetoric of ‘no decision about me without me’ the rights of patients and the public to be consulted on key decisions are weak. Far too much is left to the discretion of professionals to decide when and how people are involved. Age UK wants to see the Bill amended to give patients and the public a much stronger voice.
  • Ensuring accountability. Health services are hugely important to local communities and should always be accountable to their community for their performance. GP consortia should have a duty to be open and transparent, and should be answerable to elected local councillors for their performance as well as the NHS Commissioning Board.
  • Stronger Health and Wellbeing Boards. Health and Wellbeing Boards have huge potential to improve coordination and integration across health and social care. However, they need to have enough power to make sure that GP consortia and the local authority follow through on their recommendations.
  • Promoting integration between services. Better integration between different health services is vital if care is to be improved for older patients. Age UK wants commissioners and local authorities to be required to promote integration and coordination. This will also mean ensuring Monitor works in the patient interest by promoting integrated services.

The decision to ‘pause and listen’ has been welcome. NHS reform is a very serious matter that needs serious public debate. Yes a decision needs to be made but better the right decision than a rushed one. It is vital the Government gets these reforms right for people in later life. After all, getting it right for older people is fundamentally about getting it right for everyone.

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