David Brindle.jpg

Reflections on the NHS Long-Term Plan

A blog from David Brindle

Monday, February 18, 2019

David Brindle is the Guardian’s public services editor.

 

David chaired the Respiratory Futures panel debate at the BTS Winter Meeting 2018: can integration reboot the nation’s lung health? Listen again here.

What’s a few weeks when you are planning for a decade? The NHS long-term plan may have been delayed, like much else in a political world preoccupied by Brexit, but when it finally emerged in January it did so to broad acclaim – not least in the field of respiratory health.

 

Mike Morgan, national clinical director for respiratory services at NHS England, reckons the plan presents the specialty with a “fantastic” opportunity to make a step change in the way care is delivered and, thereby, in outcomes for patients. “The stars are aligned for respiratory medicine,” he says. “It could not be a better time to be a respiratory physician, but we have to take advantage.”

an observer of the vibrant Respiratory Futures panel debate at the BTS Winter Meeting – theme: “Can integration reboot the nation’s lung health?” - would have been left in no doubt about the wisdom of the old maxim, where there’s a will there’s a way
David Brindle

 

Morgan has a rider to that, which we will come to, but he echoes a widespread view that the plan offers not just physicians, but all those engaged in respiratory services, a platform on which to build truly integrated care. This is not only because the specialty is given priority status in the plan, which is key, but also because the 120-page blueprint for the next 10 years of the NHS is fundamentally all about integration. Its bold target is for the whole of England to be part of an integrated (or, at least, integrating) system by 2021.

 

There are, it must be said, hard questions about how that will be realised. After the initial exhileration generated by the plan’s publication wore off, some analysts who pored over the detail could not quite see how it all stitched together – particularly in the assumed absence of any legislation to facilitate the new system. They spotted gaps, too, around multi-morbidity, patient and community engagement and the future of waiting-time targets.

 

But an observer of the vibrant Respiratory Futures panel debate at the BTS Winter Meeting – theme: “Can integration reboot the nation’s lung health?” - would have been left in no doubt about the wisdom of the old maxim, where there’s a will there’s a way.

 

Testimonies from the expert panellists, but also from a packed audience,  reflected what people of vision and determination have been able to achieve even without the kind of following wind that the long-term plan will bring. Critical factors that were identified included chiselling out “head space” to enable clinicians to have the time and wherewithal to lead on integration; not seeking to reinvent the wheel but learning lessons from comparable work in other specialties, such as cancer alliances; and, when necessary, being prepared to take considered risks.

 

Binita Kane, integrated respiratory care clinical lead for Central and South Manchester, admitted that she had made “quite big decisions” about shifting treatment into community settings. “If that goes wrong, I will stand up in the coroner’s court and take that,” she said, adding hastily that she had not been called upon to do so and that here had, indeed, been no adverse incidents.

 

The panel agreed that some external facilitation would be needed to realise integration, in particular the provision of incentives for hospital trusts to release clinicians to work in community settings. There was agreement also on a need for new and more accessible language to describe emerging structures and processes: “integrated care systems” or ICSs, due to cover all England by 2021, not being a term expected to set many pulses racing. 

The stars are aligned for respiratory medicine ... It could not be a better time to be a respiratory physician, but we have to take advantage.
Prof. Mike Morgan
National Clinical Director - Respiratory, NHSE

 

Morgan, who confesses to not fully understanding some of the NHSE jargon himself, says that from April – when respiratory care becomes an NHS RightCare national priority – the existing COPD pathway will be complemented by work to develop asthma and pneumonia pathways. RightCare will meanwhile propose three “high impact” interventions for local commissioners to adopt; and commissioning networks, or collaborations, in the north, midlands and London will be reinvigorated. All in all, the specialty will start to feel busy.

 

His one rider? That in all the media coverage of the long-term plan, even in the medical press, respiratory care warranted barely a mention. The specialty, he warns, will have to shout louder and longer to remind people, especially decision-makers, that it is now a priority area. That may be no bad thing.