Now is not the time for top-down NHS reorganisation

The government should pause before embarking on disruptive reform to health and social care.

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The acute pressure of the coronavirus pandemic is starting to ease, but our NHS is clearly facing huge challenges. We need new, creative problem-solving to protect the healthcare system and innovation has a strong role to play. Luckily, one of the lessons of Covid-19 is that the NHS is more than able to rapidly innovate.

This should be no surprise. Throughout its history the NHS has been at the forefront of innovation. But what has been remarkable this past year is the way innovation has sped up. In the face of the biggest public health crisis in living memory, the NHS has pulled together to produce some incredible results.

We have seen the NHS contribute to life-saving research, finding new drugs, vaccines and care pathways that have given us a fighting chance against this virus. Millions of people around the world will benefit from findings made possible by joint working between scientists, researchers, patients and NHS staff. It should be a source of immense national pride.

Read more: “The pandemic has shown the best of humanity”

We have also seen digital innovations rapidly mainstreamed – from remote consultations to expanded use of NHS 111, to new tools for patients to manage their own conditions and symptoms. These have some clear benefits, like convenience for patients and fewer unnecessary trips to A&E. But improvements haven’t only been top-down. Different innovations have developed around the country, as areas were given flexibility to trial the use of locally relevant solutions to problems the pandemic had caused.

There has also been a huge growth in new patient-led digital networks, such as WhatsApp groups for people experiencing particular conditions. These have provided support and connection when it’s been impossible for people to meet in person. The speed and scale of progress during the pandemic is remarkable. I fully support any effort to continue this rapid adoption and diffusion of innovation to prevent suffering and save lives.

While the pandemic has shown we can move faster in health innovation, it has also demonstrated the depth of health inequality in the UK. Now more than ever, the government and the NHS cannot afford to leave anyone behind.

Tech-driven healthcare has serious risks around inequality. Digital exclusion is a major challenge – around nine million people in the UK are unable to use the internet or their digital device by themselves. And 16 per cent of the population aged 16 and above simply do not have access to a smartphone. It is still an expensive luxury for many. And for some people, a digital consultation just won’t be good enough. Patients with complex care needs and multiple conditions are unlikely to see increased quality or convenience of care from a five-minute phone call. Digital consultations can also add pressure to hard-working doctors, who are asked to make rapid and important clinical assessments without face-to-face meetings.

Read more: “Help for my junior doctors isn’t there”

It is essential that the expansion of digital healthcare ensures services are flexible enough to provide quality, accessible care to those without the skills or technology to engage with the internet. The government also needs to think more about which patient groups would be disadvantaged by digital-first care. Without these considerations, there’s a real danger that over-reliance on digital services could exacerbate inequalities.

As well as the NHS’s ability to embrace innovation, the pandemic has demonstrated the huge benefits to be found when the NHS, social care, local government and wider partners collaborate. We have known for a long time that joined-up services are better for patients, but the crisis of the pandemic rapidly expanded partnership working for the benefit of patients and communities.

Now, the government says its recently announced plans for a major structural reorganisation of the NHS aim to promote more integrated working across the health and care system. But the scale of the challenges facing health and care is immense. We are still deep within the biggest public health crisis that the NHS has ever faced. Staff on the front line are exhausted and underpaid and are now delivering the largest vaccination programme in living memory. Shockingly, over 220,000 people have been waiting more than a year for hospital treatment – 130 times higher than before the pandemic. There is also a deepening workforce crisis and huge uncertainty in long-term funding.

So, while joined-up care and partnership working can only be a good thing, it is just not realistic to now embark upon another structural reorganisation of the NHS. The timing of the proposed reforms is ill-judged and risky, but it’s not surprising that the government has come to realise it needs to change NHS legislation.

The structure put in place by David Cameron’s top-down reorganisation of the NHS in 2012 was never fit for purpose. The reforms promised reduced bureaucracy and improved cancer survival rates, but instead demoralised staff, distracted clinicians, and wasted money. Even before the pandemic, the fragmented service we were left with was failing to deliver the co-ordinated care patients deserve.

Although we ought to support the NHS to embrace innovation (while ensuring this innovation does not exclude any patient in need), now is not the time for a massive reorganisation of health and care. When the challenges facing it are greater than ever, we cannot afford disruption and distraction.

Jonathan Ashworth MP is the Shadow Secretary of State for Health and Social Care.

This article originally appeared in the Spotlight report on healthcare. You can download the full edition here.

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