As part of our ‘What If’ series on change in the NHS, we spoke to Chief Executive and Management Consultant John Wicks and asked him: “Putting all politics aside, if you could change one thing about the NHS, what would it be?”
If I could change one thing…
I’d restore ‘Prevention of ill-health’ as a key priority for the NHS.
One of the less controversial aspects of the Health and Social Care Act 2012 reforms at the time, was the transfer of public health commissioning from the NHS to local authorities.
However, as a result, there are large swathes of the NHS that no longer regard prevention of ill-health as the NHS’s business. The rhetoric remains intact. Sustainability and Transformation Plans (STPs) – the five year strategies for health and social care for large geographical areas – identified ‘health and well-being’ as one of three key objectives (alongside quality and financial sustainability). And yet, many STPs have struggled to muster a coherent programme of work.
The even greater risk has been the decline of preventive action among CCGs. The financial constraints in the NHS have largely squeezed preventive schemes out of commissioning plans.
Where they do feature, schemes are expected to deliver a return on investment, often within the same year, or are deemed unaffordable. This sets a higher bar than almost any other form of NHS healthcare commissioning. We accept the necessity to fund the care people need in A&E or hospital at a realistic level of demand. But a proposal to employ, say, a team of alcohol liaison nurses to support people whose reason for attending A&E is alcohol-related and prevent them returning in the future has to navigate a world of business cases, investment panels and risk aversion.
And so we remain on the hamster wheel chasing ever higher levels of activity while focused, well-evidenced interventions remain unimplemented.
The emerging ‘Integrated Care Systems (ICSs) hold great promise. If they identify ‘prevention of ill-health’ as a key purpose, ICSs can help the NHS rediscover its mojo for prevention and help the NHS become a worthy partner for local authorities in improving population health.
John Wicks is a Chief Executive-level healthcare management consultant, with twenty years Director / Accountable Officer experience in Acute Hospital, NHS Commissioning and Social Care organisations, as well as experience of national policy-making and implementation at the DH / NHS England. Since becoming a freelance consultant five years ago, he has supported CCGs across the country with leadership, governance and
financial turnaround challenges. Most recently he led the mental health transformation programme for North West London STP.
With expertise in commissioning and contracting, John prides himself on his ability to forge effective partnerships across organisational boundaries to achieve common goals.
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