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Hanover - Uncertain Times Require Uncommon Sense

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17 Oct 2018

Persistent calls for increased NHS funding have been answered. Following Simon Stevens challenge to Government, the NHS will receive a 3.4% real terms funding increase over the next 5 years. No sooner had the funding boost been announced than attention turned to how to spend the extra resource and the formation of the NHS 10-year plan. Whilst the Government has set out a straw man of its priorities, the 10-year plan nonetheless presents an opportunity for stakeholders to get key issues and disease areas prioritised.

But what does this mean in practice, and what does disease prioritisation look like now? National policy frameworks, such as the NHS Mandate provide concrete commitments to prioritise a particular disease, with this reflected in other policy documents such as the CCG Improvement and Assessment Framework (IAF), in doing so providing metrics to measure progress. However, disease recognition is no longer limited to these structural mechanisms. Increasingly Ministers have found new ways to signal their support and interest for individual conditions. For example, April saw Theresa May announce £70 million to fund trials for better diagnosis and treatments of prostate cancer, while Business Secretary Greg Clark was at the forefront of outlining a £40 million investment into the UK Dementia Research Institute in March.

NHS Chief Executive, Simons Stevens recently outlined 5 priorities for the NHS 10-year plan: mental health, cancer, cardiovascular disease (CVD), children’s services and reducing health inequalities.

With cancer incidence predicted to continue to rise up until 2035 and workforce challenges and access to mental health services continuing problems, it is not surprising to see these make Steven’s list of priorities. Mental health, once not high on the agenda of Government or the NHS, has become a leading case study of a disease area getting national backing to move up the list of system priorities. A combination of greater political interest from the backbenches within Parliament and effective patient group lobbying have now resulted in a bespoke five-year strategy and a dedicated Government Minister.

More interestingly is the emergence of CVD and children’s services, with the former in particular seemingly driven by new data on health outcomes (NHS outcomes were revealed to be lagging in haemorrhagic strokes). Whilst there is also new data emphasising the impact of poverty on child health, the continued focus on prevention is also key. Take obesity, 60% more children in their last year of primary school are classified as “severely obese” than in their first year. Health inequalities unsurprisingly spans across these areas as Government and the Opposition continue to highlight disparities in healthcare across the UK.

The 10-year plan provides a window of opportunity for ‘left behind’ conditions that may have fallen off the Government’s attention, such as Alzheimer’s disease and a number of long-term conditions, to re-establish themselves, or for emerging conditions with current or projected high prevalence and mortality to break through.

However, as we move away from top down performance metrics and more localised healthcare, it is important to consider what would qualify as prioritisation in the future. While the Mandate may remain the benchmark in disease prioritisation, its fixed consultation period and limited evidence of change in the past highlights its bureaucracy and slow speed of delivery. Now may be the time in a fragmented NHS for campaigners to focus on achieving more ‘unofficial’ signals from the centre. Ministerial references or individual campaigns led by the Department can signal new areas of interest. With a new Health Secretary at the helm, ministerial input into NHS policy could increase, and therefore achieving reference in an ad hoc speech may form the basis for placing a disease on the political and NHS agenda both now and in the future.