Let’s reshape frontline care for patients from the bottom up, says Sir David Nicholson

On the eve of his retirement, NHS England CEO Sir David Nicholson sets out the transformational changes needed to improve care in the coming years.

“Now I believe the NHS needs to embark on a programme of transformational change to frontline care, arguably the most significant since its creation” he says.

“There are two big reasons why we need to do things differently.  Firstly, the NHS has to transform the way it provides care in order to deliver better outcomes for patients.

We have an ageing population, with a rapidly growing number with at least one long-term condition – currently 15 million people. If the NHS is to truly serve the public, we must offer the best possible quality of life to this expanding group of patients.

Secondly, the NHS has to change because, like every major health system in the world, we face a big financial problem for the future: the sums don’t add up. If we don’t change, we face a funding gap that could be £30 billion by 2021.

Our costs are rising as people live longer and we constantly improve our ability to treat and manage conditions that were once life threatening.  At the same time, we live in a time of austerity and we cannot bet on further funding increases.

Some will point out that we recently embarked on a major NHS reorganisation, which took effect only last year.  But this government’s Health and Social Care Act focussed, with good reason, on administrative structures.

These next changes must focus on the practical ways we deliver front-line care in our communities.  They must be recommended, led and built by clinicians on behalf of patients, from the bottom up rather than top down, harnessing the innovations and ideas of our people.”

Sir Bruce Keogh, NHS England Medical Director, has already set out a vision for urgent and emergency care, including different ways to get to help for minor problems – over the phone, online or close to home – and co-ordinated networks of emergency departments, with designated units for the most serious cases.

For example, people with multiple long-term conditions, often compounded by being elderly or frail, need a senior clinician taking responsibility for active coordination of the full range of support, from lifestyle help to a stay in hospital.

Full text at http://www.england.nhs.uk/2014/02/12/david-nicholson-6/.