Elective recovery plan

The recovery plan is frank about the scale of the challenge facing the NHS in England: it recognises there will be long waits for large numbers of patients, with the waiting list growing for more than two further years, until March 2024. We think that it is good to recognise the scale of the challenge, and was something we called for when we called for a recovery plan in our recent report.

The plan also discusses the fact that the ‘missing’ need from patients who did not come forward during the pandemic is not known; the plan is right to recognise that this could undermine the proposals.

But the plan doesn’t set clear ambitions for high performance levels after the recovery; instead, the NHS is working to much weaker performance targets for the foreseeable future (eg 95% of people get diagnostic tests within six weeks, not 99%).

The plan praises the NHS’s performance during the pandemic saying it coped ‘magnificently’. Without wishing to be churlish to the thousands of staff members who have worked so hard throughout the pandemic, we would have liked to have seen greater acknowledgement of how badly disrupted the relationship between the NHS and patients has become. Certainly, our most recent patient experience survey shows some patients do not feel well treated by the NHS.

However, other aspects of the plan address what we have heard from patients much better: efforts to reduce cancellations and improve access to diagnostic procedures address concerns raised by patients in our recent patient experience survey, for example.

We particularly welcome the plan’s commitment to better communications with patients waiting for care– something we have worked with NHS England on. We will hold NHS England to account to deliver on this commitment.

The big question

Will the plan be enough? It’s very hard to say:

To the extent that it is positive about the prospects for recovery, the plan doesn’t seem unrealistically optimistic. In areas such as targeted recruitment and plans to change how the NHS deploys resources, the plans outlined here will probably help, but we’ll only know if they are sufficient once that have been implemented.

With patients’ confidence in the NHS’s ability to recover from the pandemic already low, only time will tell if this plan’s cautious targets will be met and confidence restored.

Integration plan

The integration white paper contains all the familiar failings of current health and care policy:

• It has little concept of an active role for patients; the idea is mentioned, but it’s not central to the plans and never translates into firm action. Patient partnership requires radical structural and cultural changes and this white paper does not provide it.
• There’s no co-ordination with wider policy areas that have major effects on people’s health and wellbeing long before they have contact with the health and care system
• It talks a lot about ways of developing the workforce and assessing future need more accurately but says nothing about actually funding the necessary work to meet that need.

Does the white paper offer anything new?

Integration has been pushed many, many times before, often with little success, eg the 2013 ‘shared commitment’ to integrated care. Perhaps the immense pressures on the system, plus the legislative change, will mean things will change substantially this time.

But it is not integrated with other areas of policy – so much of the causes of ill health and inequality are liked to other factors such as poverty and as long as policy is not co-ordinated across all of government, it will fail. There is mention of joining up at a local level; but it needs to happen nationally to be more meaningful.

Person-centred care is referenced as an aim, and the reason for the integration. This is very much like what we call patient partnership, so that’s a positive. Patient-centred care is mentioned in the paper, but it is not a central concept to its ideas.

Similarly, case studies in the white paper emphasise patients talking things over with clinicians and professionals, and the two sides agreeing a course of action. But shared decision making, which with our commitment to patient partnership is of central interest to us, is never mentioned.

The paper recognises some problems we know patients faces, but not others.

• It rightly identifies poor co-ordination of care, and patients having to waste time for instance giving the same information more than once
• Issues including lack of information are addressed at length
• However, there is nothing about how these proposals will improve the extent to which patients feel they are listened to and treated with respect; this is another example of the NHS’s extensive work to gather ‘patient experience’ data not actually driving any change in patient experience
• Claims about, “meeting the needs of people previously identified as Clinically Extremely Vulnerable” and, “many other examples of reshaping services to continue to deliver care safely” do not recognise the disruption in the relationship between patients and the NHS, the many difficulties that patients have experienced, and how much patients’ confidence has been undermined.

Accountability, and patients’ rights when things go wrong

There is hardly any concept of patients having an active role in shaping services, although there are plenty of places where this could be mentioned such as:

• A new ‘shared outcomes’ framework that will make space for local leaders to agree shared outcomes for their areas - but no mention of where patients fit in this process
• New technical standards for the use of data in adult social care will be co-designed with ‘the sector’ but not mention of the people who use its services
• Proposals for a single ‘accountable’ person responsible for health and care services in each ‘place’ don’t necessarily mean real accountability: there are no new ways for patients to get things sorted out when they go wrong
• The governance of integrated care systems (ICSs) and the new ‘place’ regimes is hands off: there will still be no way for patients to assert their rights if the system is not complying with its obligations under law and regulation.