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ABHI at 30 Guest Blogs: The Pursuit of Population Health

A new long-term funding offer for the NHS – which is both substantial and yet less than most estimates of what is needed to improve and transform care – has given the NHS a welcome opportunity to take a strategic pause and consider its priorities over the coming decade.

The King’s Fund believes the NHS must now place its focus firmly on the pursuit of population health – improving health outcomes for the population as a whole, and reducing inequity in outcomes for different parts of the population. The ten-year plan being developed by the NHS must chart a course towards this goal, and rigorously assess if an initiative or programme will ‘make the boat go faster’ on this journey.

What might this mean in practice? First, it means rebalancing the focus of national priorities away from outputs and processes to outcomes. Services in today’s NHS are measured by time – 62 day waits for cancer treatment, four hour waits in A&E, 18 week waits for consultant-led hospital care. Following the path ambulance services have laid, more effort should be made to develop clinically-relevant standards that focus on maintaining and improving the health of the population. For the accountable care networks of the future it must surely be as important to tackle the issue of 20 per cent of cancers being diagnosed in A&E departments, in addition to ensuring timely treatment following a diagnosis.

Second, it means investing in the services that lie outside of hospital. The NHS could easily spend all of the new funding on boosting capacity in hospitals in an attempt to meet the access targets of today. But wiser stewardship of these resources would involve investing heavily in prevention, public health, social care, and community services. Earlier detection and treatment of cancer is vitally important. It is no less important to invest in programmes that support the public to improve diets, exercise and wellbeing to reduce the likelihood of developing cancer.

And third, the tension between systems and institutions must be resolved. Integrated care systems are leading the way in this regard, but by the end of ten years it must be the norm for leaders of individual organisations to think ‘system first’ when faced with decisions over future strategy. The days when NHS away-days would be spent on plans to increase market share and repatriate profitable activity must change to focussing on how organisations can be better and more effective collaborative partners in the pursuit of population health. Easy to say, and fiendishly difficult to deliver – although systems now come together to develop joint plans through sustainability and transformation partnerships, further legislative, political, financial and regulatory changes are now needed to reflect this new emphasis on systems of care.

So, no small task. But with a guiding northern star of population health management providing some strategic clarity, a plan can be developed to ensure the next decade is the one where the NHS transformed from being a national treatment service, to a true national health service.

Siva Anandaciva, Chief Analyst, The King’s Fund