With the deadline for organisations to respond the government’s 10-year health plan now passed, RCP officers set out their thoughts on the three ‘shifts’ proposed in the plan: sickness to prevention, hospital to community, and analogue to digital. In this first piece, Dr Mumtaz Patel, acting as president of the RCP, reflects on the government’s consultation on its 10-year health plan and focuses on the sickness to prevention shift.
The findings of the independent investigation by Lord Darzi into NHS performance made stark reading and did not come as a surprise to many of my colleagues. As I said at the time, it was welcome to see the report make clear many of the problems the RCP has been raising for years, including the role that tackling the wider determinants of health would play in reducing demand for healthcare and that our workforce is demoralised and understaffed. All three of the government’s shifts must be underpinned by actions to address the challenges faced by our NHS workforce. This is the most significant challenge facing the health system and staff will be one of the most important enablers in successfully delivering the government’s aim to ‘fix the NHS’.
The government’s commitment to make a shift from sickness to prevention one of its top priorities is a pivotal moment for healthcare in the UK. It comes against a backdrop of stark health inequalities and a rising tide of chronic illness: there is an almost 20-year gap in healthy life expectancy between the most and least deprived areas of England, with over 2.5 million more people projected to be living with major illnesses by 2040. I see this gap in my own clinical practice with my renal patients in Manchester with significant differences in life expectancy linked with deprivation.
Reducing avoidable ill health and diagnosing illness early to avoid complications and greater use of NHS resources as people get sicker is a vital part of reducing pressure on the health system in the long run. The RCP’s latest census of UK consultant physicians found that 55% have seen an increase in patients with illnesses linked to social and economic factors, and almost a quarter (24%) said more than half, or almost all, of their workload is due to illnesses or conditions related to the social determinants of health. These are not just numbers; they represent lives constrained by inequity, environments that breed ill health, and a healthcare system overwhelmed by avoidable illness.
There are three clear areas that need to be addressed to create a foundation for lasting change:
1. The root causes of illness: Government must consider the wider determinants of health to truly deliver a service that is no longer simply treating sickness. As we have long said, the NHS is in the unsustainable position of treating avoidable illness caused by ‘non-health’ factors. The proposals in the 10-year plan for health must dovetail with the work of the health mission delivery board. The factors that drive and worsen ill-health – from poor housing and air quality to lack of educational opportunities, employment and discrimination – must be tackled in a cross-government strategy to reduce health inequalities so we can reduce the number of people getting ill in the first place.
2. Preventing disease progression and deterioration with early detection and timely treatment: Preventing illnesses from worsening improves patient outcomes and reduces the need for more care later down the line that cost the patient, the NHS and the planet through avoidable use of resources. An integrated care approach, including re-designing outpatient care and addressing issues in social care, will contribute to this. Funded opt-out smoking cessation services at any point of contact with the NHS and equitable access to NHS weight management services are practical, evidence-based interventions that must be prioritised. We need to think about patient care in a more holistic way with consideration of the whole patient pathway from prevention, access to healthcare, treatments and outcomes. It should be about achieving equity in healthcare.
3. Self-management of conditions to ensure good health for longer: Better support to help patients manage their own health is critical. With more people living with multiple conditions for longer, healthcare services need to be designed around the patient and their conditions managed as a whole, rather than as individual illnesses that do not interact.
Action across these three areas – as well as threading health inequalities throughout all three shifts – is central to achieving this shift towards prevention which will bring health, environmental and economic benefits.
The government’s prevention ambitions for the NHS are a promising start, but the success of this prevention-first agenda hinges on the 10-year plan working seamlessly with the health mission delivery board and having a workforce capable of delivering the much-needed shifts within NHS care to treat illness as its earliest point.
The government must tackle what makes people unwell in the first place. We believe this requires a cross-government strategy to reduce health inequalities – a strategy that has long been championed by the RCP and over 250 member organisations of the Inequalities in Health Alliance. The creation of the government’s health mission delivery board is a positive step forward, and we hope it will be the vehicle for delivering the cross-government strategy we’ve been calling for. The work of the board must feed into the 10-year plan to ensure that action is taken across primary, secondary and tertiary prevention.
With over 6.3 million people on waiting lists, gaps in staffing and inefficiencies in outpatient care remain significant barriers to accessing care at the earliest point and preventing disease progression. Our census revealed alarming workforce gaps, with 59% of consultant physicians reporting vacancies in their departments. Urgent action to address these workforce challenges is needed – but recognising our current staffing challenges and the time it takes to train a doctor, reforming outpatient services to prioritise early intervention, and streamlining care is also essential to reducing demand on the system. A significant proportion of those on waiting lists need an outpatient appointment – a crucial point where they receive a diagnosis, advice or treatment that can be the difference between developing complications and needing further treatment or not. Without significant reform and re-design of outpatient care, alongside robust workforce measures, the NHS will struggle to shift towards a system focused on preventing ill health, rather than treating sickness.
As we say in our response to the government’s consultation, the 10-year plan must recognise the role of NHS staff in delivering the government’s vision for health and account for the impact of current workforce capacity on delivering reform over the next decade. Current assumptions about staffing numbers, capacity and retention in the short, medium and long-term must feed into the 10-year plan to ensure the vision is ambitious but feasible. As I always said, without a sustainable workforce we cannot achieve any of these targets.
We know that the NHS Long Term Workforce Plan is due to be revised in 2025. We welcomed the publication of a dedicated workforce plan in 2023 and many of its proposals, including doubling the number of medical school places. We hope the 2025 revision will – as we’ve been calling for – include much more detail on the postgraduate specialty places needed to meet patient demand, alongside a commitment to an extensive review of postgraduate training and to limit the pace and scale of the physician associate rollout. In addition to recruitment, we need to work more on retention of our staff. Our staff are tired, burnout, moral injury is becoming a norm, and we need to address the underlying issues and work to reduce the workload and improve the working environment and culture for our staff.
The RCP has long advocated for a comprehensive approach to prevention – one that considers the interplay between social, economic, and environmental factors in determining health outcomes. Getting this shift right will reap many varied rewards. We welcome the government’s focus on prioritising prevention – now it’s time for them to follow through and deliver. The RCP will continue to campaign to put prevention at the heart of government and the NHS.
You can read the RCP’s response to the government consultation on its 10-year plan for the NHS here.
Dr Mumtaz Patel
Acting as RCP president (senior censor and vice president for education and training)
