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In many ways the world seems a different place since our first Policy in Focus series appeared in March 2007.

'New Horizons' takes stock of where we are now and what has happened in the last two years.

Reports and research by Matthew Limb.

• What's happened
• Game plan
• Fit for work
• Changing lives
• In the driving seat
• Seismic shift
• The hot topics

What's happened

In many ways the world seems a different place since our first Policy in Focus series appeared in March 2007. Progress has been made on some of the then ground-breaking initiatives, such as the 18-week target, payment by results and practice-based commissioning.

The 18-week target for consultant-led services in England has largely been achieved, which, on a simple measure, is clearly a success. However, the underlying aim was also to have a favourable impact on other pathways, and achievement here remains work in progress.

Introduced in 2003, payment by results is now embedded in the system, although the development of the tariff has not been without its difficulties. The numbers of GPs signing up to practice-based commissioning continue to increase, to the extent that this is likely soon to have a significant impact on the commissioning process.

There have also been new developments, such as Lord Darzi’s Next Stage Review of the NHS in England and Dame Carol Black’s review of the health of the working age population in Britain.

The two latter pieces of work in particular have had a huge impact on the agenda.

And in addition, there have been some major policy initiatives from ministers, largely arising from concerns over obesity and other lifestyle-related health problems, such as the Change4Life programme, as well as extensive structural and organisational change in the health services in Wales and Northern Ireland.

While the initiatives may grow or change, however, the health challenges that
were driving policy across the four home countries in 2007 remain: growing public expectations and demand for more consumer choice; advances in treatments and technologies, and the concomitant increased costs; changing demographics and disease patterns; and the government’s push to reduce the impact of long-term sickness among working-age people on the economy in general and on the benefits system in particular.

And all this is being played out against a backdrop of economic problems and financial uncertainty, both at home and globally. We are in uncharted territory but one thing is clear: whatever the outcome of the 2010 general elections, we shall see a dramatic reduction in public spending. Just where and how the cuts will fall, however, remains to be seen.

Game plan

The biggest policy milestone of the past two years has been the NHS Next Stage Review produced by health minister Lord Darzi (pictured below).

His final report, High Quality Care for All, was published in June 2008 and set out the direction of travel for the next 10 years for the NHS in England. It put the case for major reform on many fronts; chiefly to improve care quality, defined as safety, clinical effectiveness and user experience.

Lord Darzi envisaged patients and frontline staff driving this agenda forward. He believed this would ensure more personalised and locally determined care, based on strong evidence of the benefits for individuals’ health and well-being.

As a result, quality of care, ‘from the frontline up,’ is to be systematically measured and published, including patients’ own views of the success of their treatment and the quality of their experiences.

Lord Darzi also underlined the need for more innovation and called for improved access to a wider range of community-based services such as self referral to physiotherapy, which has since been adopted in the NHS operating framework.

Primary care trusts in England are now looking to implement his vision as they transform their organisational structures to separate their commissioning and provider functions. By October this year PCTs, as commissioning bodies, should have drawn up business plans setting out how they will increase patient choice and improve services.

Fit for work

In March 2008, Dame Carol Black, the national director for health and work, published Working for a Healthier Tomorrow, a major review of the health of Britain’s working age population.

Her report underlined the benefits of work for people’s health and well-being and the harmful effects of long-term unemployment and prolonged sickness absence.
She recommended easily accessible ‘fit for work’ schemes for those who develop a health problem, as well as better health promotion and improved help to support those out of work.

The following November, the government published its response, Improving Health and Work: Changing Lives. Included was the decision to pilot Dame Carol’s recommended fit for work service, aimed at helping people with sickness or injury to stay in, or return to, work.

Between now and 2011, these pilots will test different models providing integrated access to services such as musculoskeletal and psychological therapies and work-related health initiatives. Bidders will include different bodies working closely together with employers, such as health and local authorities and those from the independent and voluntary sectors. Local groups of public sector organisations, known as eligible partnerships, can also apply to host a pilot in their area.

The government is also reviewing the NHS’s role as an employer in relation to the health and well-being of its staff.

Changing Lives

In 2008, a NHS Information Centre report, based on the National Child Measurement Programme in which one million schoolchildren were weighed, warned that without intervention 90 per cent of today’s children would be overweight or obese by 2050.

The government’s Change4Life agenda is designed to tackle that obesity ‘time bomb’ by ensuring wider take-up of a healthy diet and exercise programmes. Health secretary Alan Johnson says the initiative aims to achieve a ‘lifestyle revolution’.

In January 2009, the Department of Health launched a major TV advertising campaign, warning people that too much body fat increased their risk of developing type 2 diabetes, heart disease and certain cancers.

The government has invited health, voluntary sector and other organisations, including food companies and supermarkets, to become campaign partners, and the CSP has signed up.

The Society’s own soon-to-be-launched Move for Health campaign – while having a clear physiotherapy focus and aiming to reposition the profession in the public’s mind – will also link into the government-backed programme.

The government says the contribution of healthcare practitioners to the overall agenda is crucial as they are often the first point of contact for young families with at-risk children.

In the driving seat

Events in Wales have moved fast over the last two years and the NHS is in the throes of a major reform.

In October 2008, Welsh health minister Edwina Hart (pictured above) outlined plans for new structures designed to put more emphasis on preventive, primary and community services, and also to put the citizen in the driving seat. Seven new integrated local health bodies are due to replace 22 local health boards and seven NHS trusts, and to be fully operational from October.

The Welsh government’s primary care implementation plan will see more care moving into primary and community settings. Other moves include the setting up of a new national advisory board to be chaired by the health minister, a delivery board responsible for operational performance, a unified public health service and strengthened community health councils.

While the aim of integrating services in order to improve access has been welcomed, some critics have expressed concern about how the new systems will work in practice and whether the moves have been adequately funded. The reforms are taking place against a background of financial difficulties and some very tight budget settlements, which has led to some physiotherapy posts being lost and vacancies frozen.

At the same time, however, Ms Hart’s recent decision to create posts for directors of therapies and health science on the local health boards – after some intense lobbying by professional bodies – is seen as a great opportunity for allied health professions to demonstrate their value and to help shape services.

Seismic shift

Northern Ireland is in the midst of what has been described as the biggest shake-up of health service structures for a generation, and all eyes are on how the reforms will be implemented.

New structures that came into force on 1 April this year include a single strategic health authority to replace four regional health boards, a new regional agency for public health and well-being and five local commissioning groups, the latter to be coterminous with five ‘super-trusts’, established last year.

The commissioning plans, yet to be published, are regarded as a key factor in the success or otherwise of the restructuring. If the commissioning groups are given the powers that they need to commission services effectively, this should see a shift away from the large acute centres towards community-based services, perhaps delivered more by multidisciplinary teams.

 

As far as the allied health professions are concerned, lobbying by the professional bodies has resulted in a pledge to include an AHP representative on each of the local commissioning groups, but critics say that the Department for Health, Social Services and Public Safety should have given a firmer steer on AHP representation at trust level. Trusts, they claim, are being left to make their own decisions, which is a missed opportunity for AHPs.