Weekly political news round up – 26th June 2015

June 26, 2015 in News by Whitehouse

Around the sector

In a comment piece in Health Service Journal, Harry Quilter-Pinner from the think-tank Institute for Public Policy Research (IPPR) argued that Payment by Results (PbR) is incompatible for the Five Year Forward View as it incentivises processes rather than incentivising providers to delivery patient outcomes. Quilter-Pinner said that PbR ties the clinicians’ hands when offering treatment: if they decide they want to provide a different type of care, they risk not getting paid. Instead, he argued that a payment system should be introduced which incentivises outcomes. To do this, he said policy makers should make it easier for CCGs to drive changes, and make knowledge about new payment models more readily accessible.

The Treasury’s proposed £200m cut to local government public health budgets is as a result of the identification of a £200m underspend in 2013-14, which the Treasury assumed was in place every year. Paul Blantern, chief executive of Northamptonshire County Council – the council with the largest public health underspend in 2013-14, said that the underspend was part of an earmarked reserve to be spent on the reorganisation of public health over the next few years.

The former Care and Support Minister and current Liberal Democrat leadership contender, Norman Lamb, has claimed that NHS England chief executive Simon Stevens “would know that it’s virtually impossible” to achieve the planned £22 billion efficiency savings by 2020 outlined in the Five Year Forward View. Lamb added that “everyone on the ground knows just how impossible it is”.

Health Secretary Jeremy Hunt has told the British Medical Association (BMA) that his pledge of 5,000 extra GPs by 2020 is “a maximum possible figure rather than a firm target”.

ConservativeHome publishes list of Conservative select committee members

ConservativeHome has published a list of the Conservative members of the Health and Education select committees, as well as ten other select committees (available here). Below is an overview of the relevant appointments for the PCF:

Health: Chair – Dr Sarah Wollaston

  • Dr James Davies*, Andrea Jenkyns*, Andrew Percy, Maggie Throup*, Helen Whately*

Education: Chair – Neil Carmichael

  • Lucy Allan*, Michelle Donelan*, Suella Fernandes*, Lucy Frazer*, Caroline Nokes

* Newly elected MPs

Accelerated Access Review champion issues call for ideas on how to improve the NHS

Hilary Newiss, the chair of National Voices, a coalition of health and social care charities in England, has announced that she has been asked the be the ‘patient/user champion’ for the Accelerated Access Review. This review will look at barriers to the uptake of new medicines, devices and diagnostics, with a view to streamlining access to them.

Newiss said that she is particularly interested in hearing from people or organisations which:

  • have been to hospital or your GP and been driven wild by bureaucracy or waste
  • have not had the right treatment for your needs
  • have a good idea for a missing piece of technology/device/diagnostic which would improve lives
  • see opportunities for patients to have better information and more say
  • see ways to make taxpayers’ money go further

Public Health (Wales) Bill: Welsh Health and Social Care Committee launches call for written evidence

The Welsh Health and Social Care Committee has published the Terms of Reference for its inquiry scrutinising the Public Health (Wales) Bill.

As part of the inquiry, the Committee will consider the need for the Bill to, amongst other measures, a requirement for local authorities to prepare a local strategy to plan how they will meet the needs of their communities for accessing toilet facilities for public use.

The Committee will also look at whether there are any unintended consequences arising from the Bill; the financial implications of the Bill; the appropriateness of the powers in the Bill for Welsh Ministers to make subordinate legislation; and the extent to which the Bill reflects priorities for improving public health in Wales.

The Committee has subsequently called for written evidence from interested stakeholders to inform its report and recommendations to the Welsh Government. In particular, the Committee has asked for written evidence on specific consultation questions relating to all aspects of the Bill. The Committee’s oral evidence sessions, which will commence on the 1st July, will only focus on Part 2 – tobacco and nicotine products; Part 3 – special procedures; and Part 4 – intimate piercing.

Part 6 of the Bill includes provision to require local authorities to prepare a local strategy to plan how they will meet the needs of their communities for accessing toilet facilities for public use. The questions under this part are:

  • What are your views on the proposal that each local authority in Wales will be under a duty to prepare and publish a local toilets strategy for its area?
  • Do you believe that preparing a local toilet strategy will ultimately lead to improved provision of public toilets?
  • Do you believe the provision in the Bill to ensure appropriate engagement with communities is sufficient to guarantee the views of local people are taken into account in the development of local toilet strategies?
  • Do you have any views on whether the Welsh Ministers’ ability to issue guidance on the development of strategies would lead to a more consistent approach across local authorities?
  • What are your views on considering toilet facilities within settings in receipt of public funding when developing local strategies?
  • Do you believe including changing facilities for babies and for disabled people within the term ‘toilets’ is sufficient to ensure that the needs of all groups are taken into account in the development of local toilet strategies?
  • Do you believe the proposals relating to toilet provision in the Bill will contribute to improving public health in Wales?

The Committee will report to the Assembly by 27th November 2015 and the deadline for written submissions is the 4th September 2015.

Tabled written questions on continence care

Labour MP Madeleine Moon has tabled two written questions to the Health Secretary on continence care, asking:

  • How many continence advisors were employed in the NHS in each year since 2005
  • What estimate he has made of the number of attendances at A&E because of (a) urinary tract infections, (b) catheter-related infections and (c) stoma care issues.

Welsh Government publishes a summary of Welsh NHS organisations’ compliance with fundamentals of care

The Welsh Government has published a summary of Welsh NHS organisations’ compliance with the 12 standards of care outlined in the 2003 document ‘Fundamentals of Care’. This yearly audit helps form a benchmark for organisations to prioritise local action, and also influence all Wales work to improve the standards of patient care and enhance the overall patient experience.

The report showed that 2014 saw improvements in compliance with standard 11 – toilet needs – with the overall score for compliance having increased from 83% in 2013 to 87% in 2014. Compliance was measured in two parts:

  • Whether there was documented evidence that a patient’s toilet needs/continence had been assessed and discussed with the patient or advocate. The score increased from 83% in 2013 to 90% in 2014.
  • Whether, where a patient had been identified as requiring assistance with their toilet/continence needs, there was evidence that an appropriate assessment has taken place with an up-to-date plan of care, which had been implemented, evaluated and reviewed within the agreed timescale. There was a minor improvement – from 82% in 2013 to 83% in 2014.

The overall user experience score for standard 11 rose from 94% in 2013 to 96% in 2014, with 96% of patients feeling that they received help quickly and discretely to use the toilet.

The report concluded that while there has been an improvement in scores for this standard compared to 2013, work needs to continue on the assessment and planning of patients’ toilet and continence needs.


Weekly political news round up – 19th June 2015

June 19, 2015 in News by Whitehouse

Around the sector

Conservative MP Dr Sarah Wollaston has been re-elected as chair of the Health Select Committee, beating fellow Conservative MP David Tredinnick by 532 votes to 64. Meanwhile, Conservative MP Neil Carmichael has been elected as chair of the Education Select Committee in a close contest, beating Tim Loughton in the 2nd round of voting by 294 to 252.

Healthwatch has published a seven point action plan outlining changes that need to be made to improve the health and social care complaints system. It calls for the establishment of a national organisation which provides patients with information on how to raise concerns, as well as a single advisory service to provide users of both the NHS and social care with the same level of support. It also calls for action to be taken to improve the quality of complaints handling, so that every organisation ensures complaints reach the right destination (and the Health and Social Care Information Centre), as well as system wide-learning for complaints and that the Governments conducts a review of the complaints system.

Health Secretary Jeremy Hunt announces a ‘new deal’ for general practice

Health Secretary Jeremy Hunt has announced a ‘new deal’ for general practice, which he described as the “biggest opportunity for general practice in a generation”. The new deal will include a package of measures designed to reduce GP workload and make the profession more attractive to new doctors starting their medical careers.

Hunt said that of a proposed 10,000 new primary care staff over the next five years 1,000 will be “physician associates”. These associate will have less medical training than doctors, but will help them diagnose and manage patients, and also relieve their administrative burdens. 5,000 of the new staff will be GPs, with the number to be reached through incentivising general practice amongst new doctors, ensuring better support for returning GPs, and helping retiring GPs work on a part time basis. Hunt added that newer GPs will be incentivised to develop specific skills in areas like paediatrics, elderly care and emergency medicine. The remaining 4000 primary care staff will be a mixture of practice nurses, district nurses and pharmacists.

As part of the new deal, Hunt said that he has asked health think-tank the Health Foundation to work with NHS England and a range of other stakeholders, including the CQC, RCGP, BMA and representatives of patients and the public, to produce a stock take of all the current metrics for assessing quality of care. The Health Foundation will provide an initial assessment in the autumn, with a view to produce datasets about key patient groups by next spring.

Also included in the new deal are plans to reduce bureaucracy and inappropriate workload, to be led by NHS England, as well as a call for GPs to play a bigger role in preventing conditions like obesity and diabetes.

When announcing the new deal, Hunt reiterated that stakeholders must work together to deliver changes and that top down direction from the Department of Health “won’t work”.

NHS Wales publishes first Annual Quality Statement

NHS Wales has published its first Annual Quality Statement, which provides an overview of the work being carried out by all NHS Wales organisations throughout 2014 to improve the quality of care for people living in Wales. The broad-ranging document covers a number of areas, including public health, patient safety and cancer, but does briefly highlight progress made to improve continence care.

The report states that continence care was looked at very closely in hospital spot checks in 2014, as NHS Wales recognises that it is “major concern” for people who go into hospital, particularly if they are older. The report said that NHS Wales wanted to ensure that people receive help to go to the bathroom if they need it, and that catheters are fitted safely in order to reduce the risk of people getting urinary tract infections.

The report also highlights that over the last three years, NHS Wales organisations have taken part in the STOP campaign to promote the safer use of catheters. This campaign urges staff to stop and ask if a device is needed, think and give attention to the clinical indicators for use, consider the options for alternatives, and prevent healthcare associated infections by ensuring the use and maintenance of devices is as safe as possible. The report states that NHS Wales has introduced a ‘care bundle’ (a combination of the safest ways of working) for catheters, which has reduced the number of infections. It also notes that Powys Teaching Health Board extended the campaign from hospitals and into the community.

The report notes that a national continence tool kit is used to assess the needs of patients and assist them if they are incontinent, with these measures being checked through the fundamentals of care reporting system. However, it found that whilst hospital spot checks have identified many areas of good practice, they also identified areas where improvements were needed.

The report identifies a number of key areas to work on over the next year, including investing in primary care and community services in order to help provide care closer to people’s homes, reducing incidences of preventable harm by using treatments which are known to work, and reducing delays in treatment.

Weekly political news round up – 12th June 2015

June 12, 2015 in News by Whitehouse

Around the sector

Health Service Journal has reported that the Department of Health will be announcing a consultation on £200 million of cuts to council-controlled public health budgets. It is proposed that the cuts will affect spending this year, and will be worth 7.4% of the £2.7 billion budget devolved to councils from the Department of Health, via Public Health England. HSJ later reported that health visitor providers have expressed fear that they will be the subject of the cuts.

The Department of Health has announced plans for healthcare regulator Monitor and the Trust Development Authority to share a single chief executive, as a way of ensuring that all NHS secondary care providers are under the oversight of one person. It is intended that the change will support hospitals to balance their books and clamp down on spending on expensive agencies. These plans will constitute closer working, rather than a formal merge.

Commons select committee chair nominations close 

Nominations for the chairmanship of each House of Commons select committee have now closed. Below is a summary of the Health and Education select committee nominees for the PCF.

Health Select Committee

  • Dr Sarah Wollaston (Conservative) – Wollaston is the incumbent, having been elected as chair in June 2014. She has a medical background, having been an NHS GP for 24 years.
  • David Tredinnick (Conservative) – Tredinnick ran against Wollaston in the June 2014 election for the position of chair, receiving just nine votes out of 433.

Education Select Committee

  • Neil Carmichael (Conservative) – Carmichael served on the Education Select Committee for five years, and established and led the APPG on School Governance and Leadership.
  • Tim Loughton (Conservative) – Loughton was Children’s Minister between 2010 and 2012 and Shadow Children’s Minister between 2003 and 2010.
  • Caroline Nokes (Conservative) – Nokes was a member of the Education Select Committee between 2014 and 2015, and has worked in cooperation with campaigns by Ambitious about Autism, the Girl Guides and the YMCA.

Care Quality Commission to assess hospitals on use of resources 

The Care Quality Commission (CQC) has announced that, from April 2016, it will judge each NHS hospital on the use of its resources as well the quality of its clinical care.

The CQC will be working with partners like NHS England and Monitor to develop an “enhanced approach”, which will form part of the CQC’s future strategy. This strategy will go out to public consultation in December 2015, with the aim of the enhanced approach being piloted from April 2016 onwards.

Dave Behan, the CQC’s chief executive, described the move as a “logical progression” of its work – one which it already has a legal remit to look at.

However, the Health Service Journal later reported that Richard Murray, director of policy at the King’s Fund, said that it would be important to see more detail on how it would work, and that the CQC would have to show its core role as a quality regulator was “untainted” by the new responsibility. He added that should the CQC be seen to make trade-offs between its roles of assessing quality and efficiency, it would “demolish” its reputation “instantly”.

Welsh Government introduces Public Health (Wales) Bill 

The Welsh Government has introduced the Public Health (Wales) Bill, which seeks to protect the health and wellbeing of people in Wales. The wide-ranging bill includes a requirement for local authorities to publish a “local toilets strategy”, including an assessment of the need for toilets for public use and details of how that need will be met.

Although no specific mentions were made of children, changing facilities for babies, as well as changing places for disabled persons, are included in the definition of toilets. The Bill also states local authorities will be required to consult with “any person it considers is likely to be interested in the provision of toilets in its area”, prior to the publication of the strategy. Furthermore, the Bill notes that Welsh Ministers may issue guidance to local authorities to consider when preparing, reviewing or publishing a local toilets strategy.  Under the Bill’s provisions, local authorities will have the ability to charge fees for the use of toilets.

Provisions to restrict child access to smoking and body piercing are also included in the Bill.

The Bill has been referred to the Welsh Health and Social Care Committee for a consideration of its general principles. The Committee will consider its approach to the Bill, which will likely include a public consultation and evidence session, in a session on 17th June 2015.

Lord Carter publishes interim report on review of operational productivity in NHS providers 

Lord Carter of Coles, the Chair of the NHS Procurement and Efficiency Board, has published an interim report of his review of operational productivity in NHS hospitals in England.

The interim report found that there was scope for up to £5 billion of savings: £3 billion through improving hospital pharmacy and medicines optimisation, estates and procurement management (£1 billion each); and £2 billion from improving workflow and addressing staffing issues. The review looked at 22 NHS secondary care trusts, examining variation in operational practices between them.

The interim report was critical of the number of product lines of procurement for everyday consumables like syringes (500,000 in the NHS compared to global best practice of 6,000-9,000), noting that Lord Carter and his review team were working with the Royal College of Nursing to agree a range of products channelled through NHS Supply Chain – although it was not clear if this was for just secondary care. It also found that company sales representatives offered value to clinicians through keeping them aware of innovations, but that their value was “clouded by the need to make sales”, and that there may not be enough nurses to meet the post-Francis demands on the NHS.

The interim report recommended that adoption of the Adjustment Treatment Index – a metric developed as part of the review which allows NHS hospitals to compare themselves with peers, as well as the development of a ‘model hospital’. It also recommended the creation of national productivity collaboratives to share best practice.

Weekly political news round up – 5th June 2015

June 5, 2015 in News by Whitehouse

Around the sector

The Royal College of Nursing has appointed Janet Davies as its next chief executive and general secretary. She will replace the incumbent, Dr Peter Carter, in July. Davies is currently its Director of Nursing and Service Delivery, and had previously been chief executive of the Mersey Regional Ambulance Service.

Healthcare regulator Monitor has published a report outlining how GP services are working for patients. The report found that most providers of GP services found it challenging to meet the needs of their patients with existing resources because of an increase in the volume and complexity of consultations. It also found that the workforce shortages and a lack of funding are constraining their ability to expand capacity in response to patient needs.

NHS England publishes Five Year Forward View: Time to Deliver

NHS England has published an update on the Five Year Forward View (FYFV), Five Year Forward View: Time to Deliver, which sets out the progress made towards delivering the FYFV, and the next steps to achieve it.

Achievements since October 2014

The document highlights that since the publication of the FYFV in October 2014, NHS England has set up 29 vanguard sites to explore new ways of delivering care, and that the Government and local leaders have unveiled plans to devolve Greater Manchester’s £6 billion health budget in 2016/17. Additionally, it notes the establishment of independent taskforces to tackle cancer, mental health and maternity services, as well as a 10 point plan for primary care and the formation of the NHS Five Year Forward View Board.

Included in the document is a summary of recently announced plans to reduce agency staffing spend, adding that Health Education England (HEE) will work with the Workforce Advisory Board to tackle the underlying cause of the growth in use of agency staff. Action will also include extending the national Return to Practice Campaign, sharing best practice on staff retention, supporting flexible working, and reducing staff sickness rates. The document also reiterates plans to reduce spending on consultancy services by requiring all consultancy contracts over £50,000 to have advanced approval from the relevant oversight body.

Delivering the vision for 2020

The document notes the three underlying principles for change in the FYFV: addressing the funding and efficiency gap, closing the health and wellbeing gap, and closing the care and quality gap.

Closing the funding and efficiency gap

The FYFV stated that an additional £8 billion of funding per year was required by 2020, as well as £22 billion of efficiency savings per year in the same period, to close the funding and efficiency gap. This section outlined three main areas where the NHS needs to take action on funding:

Maximising the value of our £115 billion spend

NHS England, in partnership with Public Health England, will be rolling out RightCare’s NHS Atlas of Variation to all CCGs, as a tool for benchmarking costs across comparable areas and helping providers understand how they could change spending patterns to achieve better overall value.

To assist in addressing the variation in prices paid for goods between hospitals, NHS England will set “clear expectations and incentives” for the procurement system to improve, ensuring consistency of approach and alignment between the different national bodies. This work will be underpinned by making improvements to how payment system incentives are set.

NHS England will also develop a common, comparable measure of the good use of resources in the NHS, and ensure insights about service quality and use of resources sit alongside each other. It will support providers by making transparent and high quality productivity information available, building on the benchmarking work that is being developed by the NHS Procurement and Efficiency Board review, so that it can lead the conversation about areas for improvement and greater efficiency.

Preventing and managing demand

In addition to discussing a renewed focus on obesity, diabetes and smoking, the document states that supporting people to manage their own health and healthcare can both improve outcomes and reduce costs – something that 70-80% of the approximately 15 million people with long-term conditions could benefit from. It notes that the Expert Patient Programme suggested that a typical investment of £400 per patient could save about £4000 per year. The document adds that NHS England will develop tools for identifying and managing people at risk of having their health deteriorate to a point where they require significant NHS resources.

Redesigning more productive services

The document stated that lessons learned from more effective models of care could help inform the design of services elsewhere, such as Multispecialty Community Providers, which incorporate some acute specialists to provide integrated specialist services in out-of-hospital settings.

Closing the care and quality gap

As already outlined, NHS England will continue to support vanguard sites to develop better models of care, which can then be replicated elsewhere. These sites will receive support from Health Education England, through Local Education and Training Boards, to support the development of the new workforce required to deliver the new care models. By July, NHS England will publish a support programme to tackle common problems and accelerate implementation of new care models being trialled by the vanguard sites.

NHS England will be introducing a new regime of support for whole health care economies to help create conditions for success – the ‘Success Regime’. This new approach will work across whole health care economies rather than just individual organisations, and will support them by diagnosing their problems, identifying changes required and implementing them. They will strengthen local leadership capacity and capability, and consider how new care models might form part of the solution. The first health economies to benefit from the Success Regime will be North Cumbria, Essex, and Northern, Eastern and Western Devon.

Closing the health and wellbeing gap

To help prevent ill health caused by preventable disease like obesity and diabetes, NHS England will be establishing a national prevention board, chaired by Public Health England and reporting directly to the NHS Five Year Forward View Board, which will be composed of the CEOs of the seven national leadership bodies. Diabetes prevention will be the board’s initial focus.

Delivering together

NHS England have asked a range of stakeholders to come together and agree how best to implement the changes, stating that changes can only be achieved if health service leaders work with stakeholders like patient groups, business, frontline staff and local/national government partners.

Over the next four months, action will be taken on the following:

  • Closing the finance and efficiency gap: The NHS Confederation and NHS Providers will work together with other partners to lead a series of round table discussions, bringing together local and national leaders from all professions and sectors, on behalf of the Finance Board.
  • Closing the care and quality gap: The Stakeholder Forum of the National Quality Board will lead a series of engagement events through their existing networks on how we can best close the quality gap, working with the stakeholder forum of the New Care Models Board.
  • Closing the health and wellbeing gap: The Stakeholder Forum of the Prevention Board will work with the LGA and representatives of the People and Communities Board to lead a series of engagement exercises through their existing networks on how we can best close the health and wellbeing gap.

NHS England chief executive Simon Stevens announces priorities and challenges for the NHS

Alongside the publication of the Five Year Forward View: Time to Deliver, Simon Stevens provided more detail on his vision for the future of the NHS in a speech to the NHS Confederation annual conference, and an interview with the Health Service Journal and another the BBC’s Andrew Marr Show.

In these interviews, Stevens admitted that the NHS is under pressure due to a growing and ageing population, and that the NHS has to make £22 billion of efficiency savings per year by 2020, in-hand with the £8 billion extra funding per year promised by the Government in the same period.

He said that NHS England would be “going hell for leather” on its programme, which will have to deliver “about the same quantum of efficiency” over this Parliament as the last, “but obviously through somewhat different means”. He added that the efficiency drive was not being done “simply out of necessity”, but out of a “sense of obligation”, and that there was a need for “honest and balanced conversations about the level of demand and activity” that the NHS faced.

Stevens said that the next four months would see the national leadership bodies work with frontline leaders to develop solutions on a national and individual organisational level. He stressed that less inclusive approaches to develop a “how to make savings” document would be a “David Brent approach”. He also added that the NHS was committed to working with national organisations to start a process for front-line leaders, patient groups and other partners to work with the NHS and the NHS Procurement and Efficiency Board to feed into the autumn Spending Review.

In addition to what was discussed in the Five Year Forward View: Time to Deliver, he said that he would introduce options for struggling CCGs other than simply changing leadership. He said that other CCGs or a local authority could take on the responsibility for struggling CCGs, or that an “integrated provider” as part of NHS England’s vanguard programme could take on “delegated responsibilities”. He highlighted that struggling CCGs had “disproportionately” not been using commissioning support units or shared back office support.

He also rejected claims from clinicians that there were too many managers in the NHS, noting that the UK spent less than 3% of the NHS budget on administrative costs (compared to 5% in Germany and France) and that the last five years had seen a big increase in the number of nurses and doctors. He said that there was a need to recognise the work that managers were doing, rather than denigrate them.

Stevens argued that the NHS had systematically underinvested in GPs for the last ten years, with GPs handling 90% of the workload but only receiving 10% of the funding, adding that there had to be more team working in primary care, including better usage of pharmacists and nurses.

Health Secretary Jeremy Hunt announces the development of performance metrics for quality, experience and prevention

Speaking at the NHS Confederation annual conference, Health Secretary Jeremy Hunt announced that the Government would be working with think-tank the King’s Fund to develop transparent outcomes-based performance metrics for quality, experience and prevention, targeted at CCGs, secondary care, specialist, primary and community co-commissioning. These metrics will focus on five key patient groups: older people, those with long-term conditions, people with mental health conditions, children and mothers, and the healthiest.

Writing several days prior in the Telegraph, Hunt also said that it is “time to take a long, hard look at whether the NHS spends its resources as carefully as it should”, but allayed fears that spending cuts would lead to a diminished health service by noting that “it is no coincidence that the safest hospitals both in this country and abroad have some of the healthiest finances among their peers”.

The Department of Health subsequently published new financial controls intended to cut down on wasteful NHS spending in order to help meet the yearly £22 billion efficiency savings target by 2020. These controls include collective negotiation by the NHS with suppliers, restrictions on the usage of agency staffing, and a cap on management consultancy contracts.

Nuffield Trust speculates on ten key health and social care priorities for the new Government

Health think-tank the Nuffield Trust has outlined ten possible key health and social care priorities for the new Government, covering funding and finance, quality of care, new models of care and workforce. These priorities are to:

  1. Address the funding crisis facing the NHS by:
    1. developing a plan to enable NHS hospital trusts to achieve financial balance over the next two to three years
    2. committing to bringing in the £8 billion minimum of extra funding smoothly over the course of the Parliament
    3. demonstrating that this will be sufficient to support the transformation of services and to deliver on pledges such as moving to a ‘seven-day’ NHS
    4. publishing the assumptions underlying the £22 billion of required efficiency savings.
  2. Commit to a fundamental review of health and social care funding that involves all major political parties.
  3. Review the problems in the management and culture of the NHS and work across organisations to set in place an action plan to tackle them.
  4. Review the effectiveness of performance targets in the NHS, starting with the four-hour A&E target.
  5. Tackle the imbalance experienced by those accessing mental health compared to physical health services.
  6. Set out a credible and funded plan for improving people’s health and wellbeing through effective prevention of ill health
  7. Ensure that initiatives aiming to transform health and social care are adequately supported and evaluated, given time to succeed (or fail), and can be adopted in other areas.
  8. Support and encourage the development of new care models in general practice and wider primary care.
  9. Reconnect with the core NHS workforce in order that they are engaged and empowered.
  10. Help the NHS implement successful workforce development and planning that realigns ways of working with the needs of patients.