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Do Not Let This Be Framed Only As A 'Winter' Crisis

13/01/2017 16:30

In the American sitcom Modern Family, soon-to-be-married Cameron and Mitchell find relatives keep talking about their 'gay wedding'.

It's a wedding, the couple explain patiently. 'Just a wedding'.

What's happening in the NHS right now is no laughing matter of course, but if feels like a similar corrective is needed.

There is no 'winter crisis' in the NHS.

What the NHS is facing - and has been for some time - requires no prefix. It is simply a crisis.

This may sound like semantics and almost trite when patients are dying, but there is a very serious point to be made here.

Calling it a winter crisis implies it is seasonal - temporary. When the daffodils emerge, the pressures will recede.

This is how the debate is being framed, particularly by Theresa May and Jeremy Hunt, who repeatedly bring winter into the debate as though the autumn, summer and spring that preceded it were fine.

The pressures are nothing new, they are going nowhere and we must not allow the idea to take hold that there is anything temporary at all about what patients and staff are currently facing.

We cannot allow the big decisions to be postponed when it is so abundantly clear that action is needed now.

By action, I mean a significant injection of funds, sustained over the coming years, to allow the NHS to stabilise, rebuild and remain the wonderful public service it has always been long into the future.

Yet with the prime minister holding firm to the belief that her government has pledged enough money and the rest can come from efficiencies, it feels like we are at an impasse.

Indeed, so firm has the government been that any crack in that position will now be a significant climbdown and that creates a disastrous position for the NHS to find itself in.

It's little wonder that Simon Stevens, the chief executive of NHS England who is said to have been briefed against by Number 10, came out swinging in front of a parliamentary committee this week.

Mr Stevens made it clear that without additional funding, the future looks bleak and put the ball very much back in the prime minister's court.

So what can be done?

More money is needed but how much depends on what we are trying to do - and this is where the prime minister could find a way out of the intransigent hole she has dug for herself.

We can't just bail out the existing model and wait for the next deterioration. Money upfront is needed, but would only be a temporary solution.

It's clear that the NHS needs a whole-system transformation and that's what Mr Stevens is looking to achieve with the Five Year Forward View (FYFV).

This document, published in 2015, sets out of a vision of taking services out of hospital and delivering more care closer to home.

This means more community rehabilitation and care to help get patients discharged from hospital and preventive services to reduce the number of people admitted in the first instance.

It also places a heavy emphasis on primary care, expanding the team in GP surgeries so that patients can see a wider range of professionals - including physiotherapists - as a first point of contact.

As the National Audit Office noted this week, areas with that broader offering record fewer A&E attendances, so we can see how the plan offers system-wide solutions to some of the sharpest problems patients currently face.

This is an eminently sensible approach - and remarkably where NHS politics is concerned, has a broad consensus behind it.

But it needs to be properly funded so that this transformation can take place - and bed in - alongside existing services, not simply taking over once they are closed.

Without that overlap, there is a serious risk of patients receiving no care at all and any new models of care will start on the back foot dealing with another crisis.

Yet, evidence is emerging from the local plans that are being developed to implement the FYFV that a lack of money is hampering those efforts and forcing cuts that will only further weaken what the NHS can offer patients.

If I were Theresa May I would give Simon Stevens what he wants.

I would say, there's your money, now make it work over the next two to three years.

Take the short-term pain - it will be lost amongst the noise if she triggers Article 50 at the end of March anyway.

Give the NHS want it needs to deal with the immediate crisis and make the changes it needs for the future.

If it works - and I truly believe it can and will - then the political embarrassment of being forced to change course will be long forgotten.

And Mrs May's 'winter crisis' can remain just that, with no need to remove the prefix.

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