09 September 2024
I’m delighted to kick off this series of blogs over the next 100 days. The blogs, written in the aftermath of the 2024 election consider what a new government means for the rheumatology community. I wanted to kick of the series by inviting the rheumatology community to consider the future direction of the speciality and the role it should play in reimagining rheumatology care.
In the coming weeks, our President Dr Jo Ledingham, and Ella Jackson, Director of Practice and Quality, will set out their thoughts on transformation in acute and primary care services, and Dr Zoe Paskins and Dr Marwan Bukhari on what this means for policy and research respectively.
“From today, the policy of this department is that the NHS is broken.”
So announced Wes Streeting on Friday 5 July, less than 24 hours into his appointment as Secretary of State for Health and Social Care. Few working in and around the NHS would disagree with him, but many leaders have been more cautious in their messaging. In June, I joined the NHS Confederation Expo in Manchester with the aim of hearing from the NHS’s non-clinical leadership - it’s good to mix things up. During their keynote speeches, the CEOs of NHS England and the NHS Confederation both used the same phrase:
“The NHS needs to be completely reimagined.”
Perhaps naively, I then spent the rest of the plenaries and breakout sessions waiting to hear about a new vision. From the point of view of working with an outpatient specialty, I came away disappointed.
Challenges in Outpatient Care
In May, NHS England in collaboration with the Royal College of Physicians, released their report on the future of outpatient care. It rehashed the well-trodden argument that the outpatient model is outdated; it re-stated the obvious, that there is an urgency for transformation; it re-rehearsed the idea of taking a biopsychosocial approach to care. There was a commitment to supporting implementation of new ideas… details of which we’re still looking out for.
But before change can be considered, the report notes that three “enablers” needed for transformation must be achieved: payment and incentives, data and information, and digital technology and IT. Changes to any one of these ‘enablers’ would involve a lengthy and costly transformation programme of its own. To their credit, the Getting It Right First Time (GIRFT) programme, understanding that services cannot wait on these on enablers, is putting out practical resources and support to support transformation. Thanks to the leadership of clinicians such as Dr Peter Lanyon and Lesley Kay, this seemingly mammoth task does have a starting point and practical tested ideas for change which have been tried and tested.
But in looking to national bodies, perhaps I’m still looking in the wrong place for the fix?
If the new Labour government has a ‘vibe’, it might be devolution of power from the centre. The NHS has struggled with this for years and Integrated Care Boards are in varying states of maturity. One of the largest is NHS Greater Manchester, an area that has benefited from longer familiarity with devolution through the seemingly successful ‘Devo Manc’ introduced in 2015. In March 2024, NHS Greater Manchester published its operational plan for 2024/25, which included the wholescale decommissioning of outpatient services from secondary care and transferring them into community and primary care. The detail at this stage is light, but year one will be when “services are realigned and sustainably transformed”...
Presumably, that starts with the payment, data and information, and digital overhaul required by the NHS England outpatient report?
At BSR, we have the privilege of working with clinicians based in all types of clinical setting, including primary and community care. For some, a shift happened out of necessity because of the pandemic, when teams were hastily moved out of hospital and into ‘the community’ and have not been able to return. Others work outside of hospitals in tailor-made facilities born out of years of strategic clinical planning and leadership, constant and rigorous stakeholder management , and considered and managed adaptation. I can only hope that Greater Manchester is looking to these latter pioneers and learning quickly what safe and effective community delivery should look like, not least because ‘community services’ has become a conveniently catch-all phrase. The reality we know is that different communities often require different solutions due to their geography, demography and workforce.
Six ‘Ps’ bind the national and local manoeuvres together: People (or Professionals), Place, Population, Processes, Productivity, and Prevention. Whilst it’s nice to find recurring themes, that also reveals the multi-faceted task at hand, extraordinarily high expectations, and a staggering complexity to the problem.
The role of the rheumatology specialty
And this is where I hope the rheumatology specialty can use its voice. Medical specialties often have a ‘character’ all of their own. Rheumatology professionals are known to describe themselves as problem-solvers. They embrace complexity. The future of outpatient care is a complex problem – what is our specialty’s vision for its own future? This is a question I’d like us to start asking at BSR and answering with input and steer from across our membership and co-designed with patient organisation partners. Because if the NHS is broken, the clinicians and patients suffering that situation day in and day out must be given the opportunity, the resources, and the tools to fix it.