Policy documents have, for decades, sketched out a more sustainable vision for our healthcare system – with an apparently clear consensus that this will be achieved by moving away from a dependence on hospitals, delivering more preventative interventions, ‘getting upstream’, joining up silos, and working better with people and communities. Such ideas are featured in the Five Year Forward View, the NHS Long Term Plan, the Future of Hospitals Plan, the Wanless review, and ‘My health, my care, my choice’, to name but a few.
Yet according to the data, we are going backwards. Investment and services are increasingly concentrated in hospitals, the share of primary care funding and staff is decreasing, community services are decimated, and the public health grant is shrinking. Resources have not followed the policy direction set out in plans. The hospital-based medical model has grown, with pressure building in emergency and outpatient services. Policymakers are now stuck in a cycle of firefighting, with each winter heralding an entirely predictable crisis.
In this pamphlet, Charlotte Augst and Paul Corrigan set out to identify the factors that have scuppered progress on this widely shared agenda, and refine the calls for change into two simple questions. First, how can the NHS work with people to keep them healthy? Second, how can the NHS strengthen the contribution people themselves can make to their health and healthcare once they have acquired an illness or an impairment?
Dr Paul Corrigan CBE served as a special adviser on health policy to Alan Milburn, John Reid and Tony Blair. He was then director of strategy for NHS London before becoming a non-executive director of the Care Quality Commission 2013-2019.
Dr Charlotte Augst is executive director for policy, campaigns and improvement at Diabetes UK. She has authored this report in a personal capacity.
She has engaged in health, care and research policymaking in parliament (for the chair of the Science and Technology Select Committee), for national regulators (HFEA and GPhC), and in the voluntary and community sector.
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