This is a Plan to put power in patients’ hands.
“My mother has dementia, and
To do that, we need to create an NHS that
delivers convenient care, at a time and
it has been a frustrating journey
place that fits around people’s lives. Where navigating between the right
it’s easy to get health advice or book a GP parts of the NHS and more
appointment. Where people can personalise
their care to their own individual needs, widely how the NHS community
choices and preferences. The NHS must work and hospital settings interact
for its patients, not demand they fit around
the way it has chosen to organise care.
with other services such as the
GP and the local council. There
Our public engagement was clear: the NHS is
far from that vision today. Too often, using is no cohesion, no clarity of who
the NHS means navigating a complex web of should help, lots of signposting
services; making many trips, at personal cost,
to see different professionals on different of services and people who
days; or being forced to constantly repeat can help but no-one taking
yourself to professionals who have not talked
responsibility for a solution.
to each other, or had proper access to your
medical records. Muhammed52, public participant,
There are 2 reasons for this unsatisfactory via Change NHS website
status quo. First, more and more staff
and resource have been concentrated in This doesn’t work for anyone. But it works
hospitals - while in parallel, hospitals have least well for those who already experience
become further distanced from many local disadvantage. They are far more likely to
communities - embedding a model where have complex needs, making poorly joined
‘you come to care’, rather than one where up care particularly ineffective. And they are
‘care comes to you’. Second, that healthcare less able to take the time off work or secure
in this country is organised into multiple, the childcare cover they need to fit into the
fragmented siloes - across community care, NHS’ ‘9-5’ appointment availability. This is the
primary care, mental healthcare, hospitals, inverse care law in practice53.
social care providers, local government and
the voluntary sector. If the NHS doesn’t feel
like a single, coordinated, patient-orientated
service, that’s for a simple reason: it isn’t one.
26
“It is a bit of a catch 22 for the The neighbourhood health service is our
alternative. It will bring care into local
NHS at the minute. Everything’s communities; convene professionals into
9 to 5 and it is also about patient-centred teams; end fragmentation
encouraging people with health and abolish the NHS default of ‘one size fits
all’ care. It will transform access to general
conditions and disabilities to get practice and prevent unnecessary hospital
back into work. So, I work as admissions. It will help reintegrate healthcare
into the social fabric of places.
much as I am able to, but those
Most importantly, it will be a service where
appointments drop in the letter
good outcomes no longer depend on a
box pretty much every week patient’s ability to navigate complexity,
and sometimes I find myself advocate for themselves loudly or skip a shift
at work. Its promise is simple: for those who
with 3 appointments across 3 have felt like the NHS is designed for almost
different days. Smack bang in anyone else, the neighbourhood health
service will put them first.
the middle of a working day. I
can either work or I can go to As first steps to deliver the neighbourhood
health service, we will restore GP access
appointments.” and ensure a far better experience of
arranging care. People with complex needs
Hannah, public deliberative event in will be offered a care plan and supported to
Leicester, November 2024 personalise their care.
27
Securing the financial sustainability of the NHS
The neighbourhood health service will not • Where Integrated Neighbourhood Teams
only ensure our model of care is fit for the have been trialled in England, they have
future. It will also put the NHS back on the significantly reduced hospital use. In
path to long-term financial sustainability. Derby86 integrated teams led to 2,300
fewer Category 3 ambulance callouts and
Our choice to do more in the community,
1,400 fewer short hospital stays among
and to bring more staff and resource into
the over 65 population within a year
the places people live as a result, will achieve
substantial value. For example, analysis • Evidence shows care plans and personal
commissioned by NHS Confederation found health budgets both improve outcomes
that systems that invested more in community and deliver value. One evaluation87 in
care saw on average 15% lower non-elective England found they delivered quality of life
admission rates and 10% lower ambulance improvements worth between £1,520 and
conveyance rates, together with lower £2,690 per patient, per episode of care
average activity for elective admissions and
• Different approaches to bringing hospital
A&E attendances84.
care to people’s home reliably show
More specifically, the more integrated value improvements. For example, one
and coordinated care provided by the trial88 found that Hospital at Home is less
Neighbourhood Health Service will support expensive than inpatient treatment, with
NHS sustainability in a range of ways: average savings of £2,265 per patient, per
care episode
• More integrated working within the NHS
– and between the NHS, local government • Our creation of digital-and-AI enabled
and voluntary sector - can deliver large modern hospitals draw on international
efficiencies. A recent systematic review evidence that they can deliver more
showed a 6% reduction in costs and a 6% productive and higher quality care. South
improvement in patient outcomes from Korea’s smart hospital network89 has
integrated care85 shown promise in driving efficiencies,
higher staff satisfaction and better patient
outcomes
We will fully digitally enable the It will be by preventing demand and boosting
Neighbourhood Health Service, with the NHS operational productivity that we can restore
App allowing patients to book appointments, constitutional waiting time standards and
communicate with professionals, see who is deliver increasingly innovative hospital care.
on their team, share their data, receive advice
By 2035, the Neighbourhood Health Service
and self-refer or tests: a ‘doctor in the pocket’
will have further evolved to fully incorporate
of every patient. For those who need them,
genomic data, digital tools and technology.
neighbourhood teams - organised around
The Single Patient Record (outlined in chapter
people with similar needs, rather than into
3), supplemented by advances in genomic
NHS institutional siloes - will deliver truly
data, will enable personalised predictive care.
seamless care, in the community. For the first
Instead of spotting a symptom and joining
time in the NHS’ history, personalisation and
a long waiting list, neighbourhood care will
convenience will become the default.
increasingly happen before a disease happens,
As we do more in the community - funded enabling a real and transformative shift to
by a reduction in hospitals’ share of total NHS prevention.
expenditure - we will reduce demand
on hospitals.
28