Dr. Robert Wallace examines the NHS 10-Year Plan, arguing it addresses real crisis but requires more than money. The plan shifts care to community centers, moves to digital systems, and emphasizes prevention over treating illness. Structural changes and workforce support will matter as much as funding.
Foreign. Okay. Hello everybody. I'm Dr. Robert Wallace. I work with SafeWorkplace. I'm the senior healthcare partner for SafeWorkplace. And my work evolves around helping healthcare organizations succeed in the area of compliance, but also in the area of outcome, which fundamentally is our aim is to get the best outcome for patients and also for staff and for organizations themselves. So today what we're going to have a chat about is the NHS ten Year Plan, the Fit for the Future plan. This is a very comprehensive plan and I think that it is a healthcare plan that should be welcomed. It is a healthcare plan that is absolutely essential. Now, it is well recognized that the NHS currently would be described as being in crisis. I think the Darcy report, I think people are or should be indebted to Darcy and the work that he and his team did because they identified and vocalized what many, many people both working in the NHS and receiving treatment in the NHS had been thinking for some time. It is unfortunate because I do believe that healthcare workers do the work that they do out of passion, out of great skill and other dedication to their patients. I think for a very long time in healthcare organizations in many countries, it has just been assumed that healthcare workers will simply continue to do their job because of this caring that they have for other people. But that's not reasonable. I think that they require a system that will support them and then ultimately support the patient. So be fair to Keir Starmritten's government. The Darcy report clearly stated that the NHS was crumbling, that the outcomes were deteriorating in the comparative to other countries, that there were very high risks to both the staff in the system, the patients in the system, and that it simply couldn't continue. So they are taking proactive measures. And this, well, 10 years might seem like a long time. Ten years is not a long time in healthcare. I've been working in healthcare for 30 years, so I can tell you the 10 years goes by relatively quickly. So if you take no action, nothing will happen. If you plan like the health that aren't fit for the future, then I believe that there will be successes. But I do also believe that you can't present a plan without the expectation that people would in a constructive way criticize that planning. So what we're going to do today is we're going to go through the Fit for Future plan. It's a very comprehensive document, but we're going to just narrow it down to the key points and maybe just share our view on it with the hope of judges contributing in some way. To the understanding of what has been proposed. So I suppose the first thing here is the Fit for the Future. The plan is based around three key things. It is to move care to the community where possible, to move from analog to digital, and to move from sickness to prevention. Basically implementation of good population health strategy. Now, before we go through those points, I think that it's important to know where you're starting from. So just to give a quick run through on the Darcy report. So Darcy was given a free hand to be as honest and as critical as was necessary. And it identified skyrocketing waiting lists and extremely demoralized staff, which is shown on an annual basis with the NHS survey. So this was already known. And also it showed that comparatively to other countries, the NHS was not moving forward. So the care outcomes were not matching those of other populations. And I think this is fundamentally the basis of this report. Okay. Of this proposal. Now we will talk about finances. So the NHS has a massive budget and in the last couple of days there's been some, not harsh criticism, but some observation that there may not be adequate finance. Implement the Fit for the Future plan. But it's not all about money. And I think that staff at the NHS will certainly tell you it's not all about money. Okay? So there are many, many positive changes that can be made without just talking about money. Okay. For me personally, I work in primary care and I have done for a very long time. I have worked in an NHS hospital, I've worked in practice in the nhs. I was aware of the CQC then. I was aware of the demands that were on the team and the clinic that I worked in, and also my own practice. I'm well aware of the demands outside of clinical care. Okay, so what might be of some help here is just a brief tangent and I'm going to mention another 10 year fit for the Future plan. And this is a plan called Schlontlicare which was implemented in Ireland in 2017. Now, at that time we also had a significant crisis with staff morale. We had a significant crisis with the demands on the health care system and with all health care systems. Again, it would be argued that there wasn't enough money. But both Ireland and the UK do significant health budget. So, you know, again, it can't just come back to money, which we will do in the later on in the discussion. So Schlongty care was implemented, ironically enough, to do the three same things that the Fit for the Future plan wanted to do. They wanted to move care to the communities. They wanted to digitize systems and they wanted to improve prevention. So public health measures and messaging. So this plan has in fact been a success, to be fair. So waiting times have reduced in Ireland. A very significant part of this was the construction, the physical construction of primary care centres throughout Ireland. So There are now 180 primary care centres throughout Ireland. These provide care for GPs, for physios, for diagnostics, for dental, for all different services. They're located in cities, they're located in medium sized and small towns even. And this is where people go before they go to hospital. And this is a fundamental element of the Fit for the Future clinic, because the cost of treating someone in secondary or tertiary health care is dramatically higher than the cost of treating somebody in primary care. And also the morbidity is much greater if you are treated in a primary care setting and your problem is resolved. Like with anything in life, if you solve it early, you prevent too much. So that part of the plan to move care to the community, to neighbourhood care centres is likely to prove to be a very positive thing. Now that will require work with the integrated care systems, the integrated care boards. But this has been included in the plan that they hope to set up a structure to allow for the best investment and the best integration. And this brings things like care homes, social care, treatment in the community, treatment care plans, wellbeing plans for patients, even employment coaching is proposed for these neighborhood centres. So I think that will be a powerful part of what they would like to do in this plan. I think what we might discuss now is the next element of the plan. So what we're going to look at here is I'm going to switch it around just a little bit. So they discuss it as hospice, the community, then digitization, then sickness to prevention. But we might talk about sickness to prevention now, okay. Because this ties in very much so with the neighborhood care centres. This is about messaging to people to improve their behavioral habits and to improve lifestyle choices and things like this. Now this is a contentious issue. Okay? So Keir Starmer has been accused of trying to implement a nanny state. Now, politically and at an individual, personal level, people could say, I don't want to be told what to do. But when the outcome, when the benefit of something is so great and if you are still left with the choice whether you would do something or not, I don't believe that that is nanny state. So I think the Fit for the Future plan, if they work with public health and population health, I think there is quite a message and undertone in the plan about wanting to reduce inequalities of health. Okay, so this goes beyond treatment. This is about.
