Why UK health and social care needs a new system architecture after COVID-19
10 September 2020
In August 2020 the UK Government announced that Public Health England (PHE) was to be folded into the new National Institute for Health Protection (NIHP). It was the first major structural change to the UK health system since the onset of COVID-19. It’s unlikely to be the last.
In fact, if lessons are learned from how the system performed during the pandemic, the changes will extend far beyond the NHS and public healthcare bodies. They’ll also address areas including the provision of social care, the relationship and balance between public and private providers in both health and social care, and how the system works with the pharmaceutical industry.
With the pandemic having laid bare the need for unwavering collaboration, it’s clear that all the nodes need to be forged together in a new way if the system is to be made ready for the 21st century. With the abolition of PHE the first sign of the wider restructuring to come, the big question is what further changes are needed to achieve this.
Less tolerance for inefficiency
The Health and Social Care Act 2012 defined the architecture of the UK public healthcare system all the way from the Department of Health (DoH) to front-line services. The private health sector remained separate and market-driven. Whatever happens following COVID-19, this basic distinction will remain in place.
However, one thing that COVID-19 has done is reduce public tolerance for inefficiency and waste in the NHS. So an overhaul of operational structures and the wider architecture is now not only necessary, but also likely to be positively welcomed by the public. This has opened up a window of opportunity for politicians and policymakers to effect fundamental changes.
Opportunities for rationalisation at the top…
With pressures on public finance intensified still further by the pandemic, one big area of opportunity is consolidation and simplification at the topmost levels of public health. As the abolition of PHE confirmed, having all three of the DoH, PHE and NHS England/NHS Improvement (NHS I&E)[RM1] was overly-complex, with roles and responsibilities that were overlapping and often poorly-defined. NHS E&I are for all intent and purposes one organisation; this is a positive thing, but it needs legislation as the final rubber stamp.
…and greater collaboration at other levels…
At the next level down, one of the main silver linings of COVID-19 has been to encourage hospitals, care commissioning groups (CCGs), GPs, the pharma sector and social care to work more closely together. In this context, a positive step is the creation of integrated care systems (ICSs), where NHS organisations partner with local councils and others to manage resources and improve public health in their area. I believe ICSs should be accelerated and rolled out to foster a more integrated – and increasingly preventative – approach to health & social care and wellbeing.
It’s at this level that we’re also starting to see some integration with private providers, although so far this has been mainly in social care. The key here is to look beyond the bifurcation between public and private providers and redesign the architecture around patient needs, addressing the current fragmentation between GPs, primary care, secondary care and social care (usually private).
The role of NHS hospitals also needs to become more integrated. It’s very rare to see secondary care physicians in primary care, and there’s a need for physicians to ally less to entities and more to patients. Meanwhile, GPs have been working together in primary care networks (PCNs), which can offer new and more integrated ways to manage the health of cohorts of patients. Like ICSs, PCNs should also be accelerated.
…including with private sector providers and pharma
Across all the changes I’ve outlined, the key to making them happen is ensuring the money flows in line with the new structure. But how will private providers fit into the new landscape? COVID-19 has seen public and private working well together, with the NHS taking beds and capacity in private facilities. The big risk now is that the NHS could suddenly withdraw this funding, potentially triggering failures among private sector providers, not least care homes.
This would harm both the public and private sides; the public social care sector isn’t large enough to manage the fall-out. And more generally, the goal for the future should be to create an environment where what matters is not the type of provider, but the quality of care – with the ability to flex between the different sources of care as needed.
The final piece of the jigsaw is the pharmaceutical industry, which is highly commercial, constantly innovating and not universally trusted. Its global scale means public policymakers often feel powerless in their dealings with it. However, as part of a broader approach to improving the country’s resilience post COVID-19, I think we’ll see determined efforts to ensure that the UK is better prepared in terms of stocks, with agreements between pharma companies and the NHS to ensure it isn’t caught short again. There are already signs of this emerging in the Government’s global purchasing of vaccines.
Zeroing in on patients
So, what will all these changes mean for the overarching goal of any healthcare system: to put patients first? The NHS was set up in 1948 for patients’ needs as they were at the time. But patients and their needs have changed – and are continuing to change. In our next blog post, we’ll look at what putting the patient first means in the UK health and social care system of the future. Stay tuned.