Dealing in Hope: four quiet victories in the NHS
There’s no doubt it is tough out there in healthcare. But if we look hard there are some important developments and reasons for optimism.
In this guest article, Tara Donnelly explores the often-overlooked advancements within the National Health Service (NHS). Despite the challenges and publicised struggles of the NHS, particularly as it marks its 75th anniversary, Tara sheds light on the 'quiet victories' that are shaping the future of healthcare in the UK.
In July 1948 the National Health Service was established in the United Kingdom - the first western country to offer free at the point of use medical care to the whole population.
At 75, the NHS appears to be struggling. However, away from the headlines and news stories on strikes, emergency care and waiting list backlogs, there are some encouraging signs. Julian Hartley, CEO of NHS Providers, told NHS leaders recently that despite the difficulties the NHS is facing currently, it is critical that leaders are “dealers in hope”.
I believe that a number of quiet victories underway have the potential to form the foundation of a new NHS that provides care that is proactive, personalised and preventative. They are far less visible than ambulances outside hospitals and perhaps therefore less appreciated, but represent important changes to our health care system.
We need to be careful about missing what we don’t see and to appreciate where most health and care takes place, and that is in our homes and communities, as Thea puts it -
“Hospitals are amazing, extraordinary, brilliant places, but as a society, we’re a bit in love with them, and I think we've got to share the love. Most health and care actually takes place outside of those hospital buildings.” Thea Stein, CEO, Nuffield Trust.
So these are four quiet victories I would like to give a shout out to -
Expansion of virtual wards
Social Prescribing coverage
More Care at your Pharmacy
New staff in Primary care
I think they position us well and we should make even more of each of these if we want the NHS to get in better shape in the future.
Expansion of virtual wards
Every part of the NHS in England (each integrated care system or ICS) now has Virtual Ward services, supported by technology, available to their residents. Around 8,000 people will have woken up this morning in their own bed, being monitored by their local NHS.
We know this is a model that the public wants. In their survey of 7,100 representative members of the public, the Health Foundation found that 78% would be happy to monitor their own health at home using technology instead of in a hospital. For those aged 65 and over, this rose to 85%. This older generation believed even more strongly than all the age groups put together that they’d be happy to be treated out of hospital using tech.[1]
So we have strong public appetite, fuelled in part by the pandemic, where people started using digital health tools in new ways. At the same time the cost of technology has dropped, and the quality has increased. It means now is a great time to act: tech enabled care at home is an idea whose time has come.
There is huge opportunity for this to grow further, such that over the decades ahead everyone with a significant long term condition receives ongoing digital support at home and it becomes very rare to reach a crisis meaning hospital care is required.
Bear in mind currently 70% of hospital beds in the NHS are caring for someone with a long term condition that has got out of control and we know that over the next 25 years, the prevalence of long term conditions will increase.
“The number of people living with major illness is projected to increase by 37% – over a third – by 2040, nine times the rate at which the working age population (20–69-year-olds) is expected to grow (4%).”[2]
What would that digital support at home look like? It would be a combination of remote monitoring, a companion app and clinical supervision - in the future augmented by AI. This would mean our precious clinical workforce could supervise a far greater patient population safely.
The difference to hospitals would be enormous; bed occupancy rates at manageable levels, a predictable elective surgical programme, far less stress and strain for staff and time to give personalised care. A big part of the solution to our twin challenges of capacity and workforce.
Social Prescribing coverage
Every GP practice now has access to social prescribers who can help people with non-medical issues that markedly affect quality of life, such as social isolation. No other country has made such a strong commitment to helping people with these factors. The Low report demonstrated that 20% of people visit a GP with non-medical needs and social prescribing was a central component of NHS England’s long-term plan to provide more personalised care and reduce health inequalities.
In this model, general practice staff refer patients to social prescribers who connect patients with community-based services to address non-medical needs. In 2019, NHS England committed to a national rollout of social prescribing by funding a link worker for each of England’s 1,300 Primary Care Networks, and there are now 3,433 people undertaking this role.
A recent review [3] of who is accessing services found the most common reasons for referral to social prescribing were mild to moderate mental health issues, specifically:
Anxiety and depression symptoms
Isolation and loneliness
Other social needs
Exercise-related referrals
Link to specific physical health conditions
Issues relating to work or finances
Struggling with life changes
Frequent attenders at primary or other NHS services
There is more to do to ensure that as wide a group as possible participates in these services, and that they do indeed reduce health inequalities, but we are starting to see a better community response for these needs that are wider than medical treatment, and enables a broader view of health and wellbeing, not just the absence of sickness, while preserving clinical time for those patients who would benefit most.
More Care at your Pharmacy
Extra clinical services are being provided locally as part of Pharmacy First and in two years every pharmacist graduating will be able to prescribe. From this month, pharmacists will be able to offer advice and where appropriate medication for seven common conditions:
sinusitis
sore throat
earache
infected insect bite
impetigo
shingles
uncomplicated urinary tract infections in women
As well as provide free blood pressure checks and support the initiation of contraception. The impact of all new pharmacists being prescribers is significant, and is captured well in this King’s Fund guest blog by Keith Ridge.
“By 2026, the aim is for all newly registered pharmacists to be able to independently prescribe medicines. […] for the profession, and for patients, it could be a revolution.
Imagine walking into a community pharmacy to have your high blood pressure or depression treated and monitored there by a pharmacist. Or imagine a hospital where a specialist pharmacist routinely leads clinical trials of new medicines for cancer, or leads and delivers rational prescribing of antibiotics. […] Or in a general practice where a clinical pharmacist reviews a patient’s medicines and rationalises them down from 10 regular medicines to 3.” [4]
New staff in Primary care
Across primary care a new workforce is taking shape, to complement the medical and nursing staff we have had since the creation of the NHS. In the past four years 29,000 people with a range of skills have joined primary care in direct patient care roles. The highest volumes include over 6,000 in pharmacy related roles including practice pharmacists, advanced pharmacist practitioners and pharmacy technicians, as well as 5,000 care coordinators. Others are physiotherapists; first contact physios and advanced physio practitioners, paramedics, nursing and physician associates, dieticians, podiatrists, trainee nursing associates and health coaches. There has been marked investment in this through a dedicated funding stream to Primary Care Networks and they are attracting new staff, keen to join the NHS, in important patient facing roles.
Together, these important developments are laying the path for care that looks very different in the future.
Tara Donnelly is the Founder of Digital Care, a consultancy supporting digital health in the NHS, with a particular focus on digital home care. She works with a range of leading NHS and digital innovator clients with her team of associates. Tara has worked in the NHS for over 30 years in operational leadership roles in London hospitals, including director of operations, managing director and chief executive. Her second chief executive role was leading the Health Innovation Network for South London, and she then spent four years at NHS England as chief digital officer, extending digital home care during the pandemic and afterwards before establishing Digital Care in March 2023. Tara is also the senior independent director at the leading think tank, the Nuffield Trust, and President of the Health CEOs’ Club. You can follow Tara here on LinkedIn.