Strategy for

Attention to determinants of poor health and focus on prevention are needed to reduce supplier induced demand.

We should:-

• redefine care in terms of maximising wellbeing

• see care as an investment not a cost

• enforce “care in every policy”

• The aims should be that:-

• those that need care and support can tailor it to their requirements, without intrusive evaluations and multiple assessments

• long term care should provide continuity based on shared planning, with as much choice as desired

• barriers to getting care and support must be lowered so that relatively modest needs are addressed before they become serious or critical

• care and support (as well as diagnosis and treatment) are delivered without lengthy waits, where possible in or near a decent home.

But the care system is in crisis, and it needs a period of stability. That means:-

• no reorganisations, major legislation, new initiatives or targets.

• adopting five year revenue and capital funding settlements

• pledge to accept recommendations of all pay reviews bodies.

There are some urgent actions:

• improve pay and conditions of care workers

• lower barriers to timely access to social care

On workforce

• tackle the causes of poor reten<on and low morale

• adapt Agenda for Change to embrace all care workers

• progress a long term plan for workforce recruitment

• optimise flow (pathways) and restore compliance with ambulance and ED targets

• challenge organisational and professional vested interests causing obstructions

• reduce waiting lists

• increase capacity to meet demand based on data analysis and flow modelling

The care system does not have the leadership or the management skills to bring about these changes quickly... ... so we need to:-

• invest in system management and in data analysis

• end top down “management by shouting”, and slim-down NHS E and DHSC

• allow genuine devolution to ICSs and end the autonomy of NHS FTs.

The public has to be mobilised as Wanless argued 20 years ago, in his “fully engaged scenario”.

This means:-

• reaffirming the core principles of the NHS – universal, comprehensive, free and funded from progressive taxation. Over time these principles should be applied to social care.

• showing genuine openness and transparency, and honesty from leaders

• boosting local accountability and engagement through Integrated Care Systems

• growing a leadership role for Tier 2 Local Authorities in service integration

• engaging with the third sector and using volunteers and community assets imaginatively.

• promoting step changes in expectations for individuals to maintain their own health and wellbeing – like a ‘contract’ between individual and state

We need a long term plan for improvement and change based on a care model built on consensus. Change must be incremental, high level and local, and managed to avoid disrup<on or expensive double running costs.

Reform should be planned over 10 years with early gains to lower barriers to access, fire up a major investment programme, reduce waits and improve quality.