The NHS has been on a remarkable journey over the past decade. Real-term spending per head has more or less flatlined since 2010, as the health service rode the business cycles of the UK economy in the aftermath of the 2008 financial crisis. Budget after Budget focused on getting the NHS through the next short period. This culminated with the Covid-19 pandemic, which laid bare years of underinvestment.
Even now, the NHS is suffering from post-pandemic fatigue. While we have all accepted that the system is fractured, focused too much on cost at the expense of value, and has run its workforce into the ground, the political instability of the last few years has seen us cycle through numerous health secretaries all looking for quick fixes.
But it doesn’t have to be like this. The Hewitt review into the oversight, governance, and accountability of integrated care systems (ICSs) was a reminder that we do have the ability to think systematically about creating better health options. The message is clear: it’s time to move away from big national and political thinking focused on short-term outcomes to an approach that allows those at the coalface of our health system to take charge.
In particular, three conclusions on ICSs stand out.
First, the NHS is only as good as its local delivery of health services. Our health system is based on a hospital model that focuses on treatment rather than prevention. Although this served us well when we had a youthful population and a growing economy, it now is incredibly expensive to keep going and is failing patients on multiple fronts. The system is inflexible, poor at delivering change, and unable to cater to the various needs of diverse communities. Consequently, we need to take a bottom-up approach, decentralising our health system and empowering local communities and health services.
Second, we need to be ruthless about ensuring that we do not compromise power and money at the local level at the expense of the primary and community level. Primary care is lacking. We have a shrinking workforce, poor infrastructure in community facilities, and a lack of collaboration as historically everyone has looked up to the NHS rather than around. Yet, study after study reveals that the hospital model is not sustainable. We must stop sending everyone to hospital and focus on keeping them at home and in the community where they can thrive.
Third, leveraging data will be essential to a new framework of health services. At UCL’s Global Business School for Health, we are experts in analysing healthcare models from around the world. We’ve looked at many countries where data is being used to treat patients more smartly from pre-diagnosis onwards. For example, in the United States, healthcare leaders in Durham County, North Carolina, are pooling data to direct health and social care. They have created an integrated data system that allows various community stakeholders to coordinate efforts and improve care in communities by democratising the local health data for tracking interventions. Similarly, Indian healthcare startup THB is making a significant difference by using health data to help stakeholders with planning and predicting diseases as well as patient risk assessments and clinical pathways. There is an opportunity to do the same through an ICS, with a focus on population health, community, and local government collaboration that includes all stakeholders.
Alongside its conclusions, the Hewitt Review does maintain an undertone of caution. As it identifies, primary and social care still do not have the ability to lean in enough next to NHS hospitals and trusts to get what they need. We also need a workforce strategy for social care, not just the NHS. The inability of the health system to transition is alarming given the evidence that our current model of care is not sustainable.
Despite this, the review is a turning point for a much-needed transformation of our health system. Now we need courageous political leaders to put aside short-termism and drive solutions that will put the NHS onto an even footing for many years from now.
By Professor Nora Colton, Director of UCL Global Business School for Health