On 16 July 2015 the Secretary of State for Health, Jeremy Hunt, set out a vision for the health service that would make ‘healthcare more human-centred and not system-centred’. His speech revolved around six key priorities, as outlined below.
1. Moving from a bureaucratic to a patient-centred service
The Secretary of State outlined his intention to move from
- a narrow focus on access targets to a broader vision of high quality care
- disjointed episodic care to holistic integrated care
- cure to prevention, with a bigger focus on public health and greater personal responsibility for wellbeing
- power lying with politician to being held by patients.
Hunt said that: ‘decades of building processes around system targets and system objectives, often with the best of intentions, have demoralised staff and patients and dehumanised what should be some of the most human organisations we have.’
2. Fostering ‘intelligent transparency’
The Secretary of State suggested that ‘intelligent transparency’ was a means to achieving an honest diagnosis of some of the challenges facing the health system. He outlined the impact of placing trusts into special measures and the improvements that had been seen as a result.
Hunt also talked about the CQC inspection regime for care homes, domiciliary services and GP practices. He outlined plans to publish more useful information on general practice, data on avoidable deaths by hospital trust and ratings of the overall quality of care provided to patient groups in every local health economy.
The Secretary of State further clarified that intelligent transparency would also mean a conversation with the public about the role individuals needed to play in taking responsibility for their own health.
3. Devolving power
The Secretary of State suggested that focusing on transparency around outcomes could make the true devolution of power possible. He said that ‘self-directed improvements is the most powerful force unleashed by intelligent transparency…if you have independent, smart measures of performance area by area, hospital by hospital, a health secretary can relax a little’.
Hunt also outlined the need to move towards population-level commissioning with locally-determined models supported by clear metrics.
4. Becoming the world’s largest learning organisation
The Secretary of State spoke of the need to turn the NHS into the world’s largest learning organisation, with learning focused on both quality and efficiency.
To support NHS providers to do this, Monitor and the NHS Trust Development Authority would join to become NHS Improvement, chaired by Ed Smith.
NHS England’s safety functions led by Dr Mike Durkin, National Director of Patient Safety, would move to the new organisation. Its early priorities would be to:
- work with the Chief Nursing Officer to complete the work started by NICE on safe staffing levels
- set up a new Independent Patient Safety Investigation Service modelled on the Air Accident investigation Branch used in aviation.
The Secretary of State also announced the start of an internationally buddying programme. Five NHS trusts (Surrey and Sussex Healthcare; Leeds Teaching Hospitals; University Hospital Coventry and Warwickshire; Barking, Havering and Redbridge; and Shrewsbury and Telford) would be partnered with the Virginia Mason health system in Seattle.
The national responsibility for developing NHS leaders, including the NHS Leadership Academy, would be brought together under Health Education England. And an update of Professor Sir Bruce Keogh’s review of professional codes of practice would be published.
In summary, the Secretary of State made an offer to the NHS of ‘more transparency in return for fewer targets. Learning and continuous improvement at the heart of a more human system where we eliminate any conflict between organisational priorities and what is right for the patient sitting in front of you.’
5. Bringing in seven-day care
The Secretary of State stated that his vision of seven-day care was not about increasing the total number of hours worked each week by an individual doctor, but instead reforming the consultant contract to remove the opt-out from weekend working for newly qualified doctors.
Hunt suggested that ‘around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals’.
He went on to say, ‘When I pointed this out to the BMA they told me to “get real”. I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to “get real”.
‘They are not remotely in touch with what their members actually believe… I will not allow the BMA to be a road block to reforms that will save lives.
‘There will now be six weeks to work with BMA union negotiators before a September decision point. But be in no doubt; if we can’t negotiate, we are ready to impose a new contract.’
7. Empowering patients
The Secretary of State outlined opportunities to make NHS patients the most powerful patients in the world. These included making electronic health records available in every care setting within the next five years, making progress in decoding individual genomes, and developing new medical devices.
Hunt described the advances in health apps that would contribute to data and power sharing between doctors and patients. He also outlined plans for GPs to tell patients about the relevant rating of a provider when discussing referral options. In addition, he spoke of future work to ensure there was a meaningful choice of services in maternity and end-of-life care, and for people with long-term conditions. In ‘under-doctored’ areas, he said GP provision would be boosted.
The Secretary of State also focused on digital inclusion. He said he had asked Martha Lane-Fox (co-founder of Lastminute.com) to develop proposals to support the increased uptake of new digital innovations.