The NHS Alliance

With it being three months since the launch of The NHS Alliance through the merger of NHS Providers and NHS Confederation, I began by asking Lord Adebowale how things have gone so far.

‘It's gone well,' he said. ‘We have a really strong culture. I don't underestimate the stresses it has caused my colleagues from both organisations who have been amazing.

‘Our members told us very clearly, very consistently that the NHS needed a much stronger and more unified voice.'

Neighbourhood health

While nothing new, delivering neighbourhood health is the big idea set out in the 10-Year Health Plan. 

Lord Adebowale said many members of The NHS Alliance have already realised neighbourhood health was the way forward.

In order for the plan to work, the peer called for ‘appropriate allocative resource means so that we get appropriate funding of acutes and the neighbourhoods'.

He added: ‘We need the technology to be enabled, but we need it to be appropriate and trusted and modern, and it needs to be aligned with the right financial incentives and the right frameworks and the right regulatory systems.'

While acknowledging the different degrees of enthusiasm for behavioural and system change within the NHS, Lord Adebowale said there was common agreement on the urgent need for a new approach.

‘The train's leaving the station,' he noted. ‘We need to invite everyone to get on it. People walk at different paces, but it's still going to leave the station because it has to.'

Lord Adebowale stressed the importance of scaling best practice around the country to accelerate neighbourhood health adoption.

‘There's a danger that we have 1,000 flowers blooming and we waste a lot of fertilizer,' he observed.

He cited a number of trailblazer examples of neighbourhood health across the country such as Fleetwood where the NHS is working with housing, the community and employment to create health.

‘Unless we start creating health, then we're on the track to continually dealing with the consequences of unhealth,' he said.

Elsewhere, Lord Adebowale cited how East Lancashire Hospitals NHS Trust had expanded its community teams and developed a 24/7 intensive home support service that includes a ‘front door' model which identifies patients who can be safely supported at home rather than waiting in A&E

In Walsall, the trust has introduced a care navigation centre and urgent community response teams that connect people to the right professional first time and provide rapid care in people's homes

And in Hertfordshire, 13,000 patients receive co-ordinated health and social care support in their own homes through a combination of remote monitoring and face to face care.

Meanwhile, Hampshire and Isle of Wight has embedded early intervention across health and care pathways  through a combination of remote monitoring and face-to-face care. . In addition, North Staffordshire Combined Healthcare NHS Trust provides year-round support for people experiencing mental health distress, alongside upstream work that promotes self-management and community-based support In the capital, East London NHS Foundation Trust and North Central London ICS have shifted investment from inpatient and acute services into community-based care that can support prevention, improve access and reduce hospital dependency.

North Central London has also implemented community services across its borough to move care earlier in pathways and strengthen out-of-hospital provision

‘The next challenge is making sure we get the financial flows to support these and get the workforce right, so they can scale, and we've got the digital and the regulatory frameworks that underpin them,' Lord Adebowale noted.

NHS restructuring

Addressing NHS restructuring, The NHS Alliance chair said he was ‘deeply impressed' with his ICB colleagues' ‘tenacity and focus on delivery and commissioning, despite the massive cuts they've had to their budgets in a very short space of time'.

Lord Adebowale said he was confident the NHS would emerge from the process ‘sharper and more focused'.

‘As painful as it is, we should end up with a clearer connection between form and function for organisations,' he added.

Lord Adebowale said he was ‘optimistic' reorganisation would not distract from healthcare delivery while expressing concern about the stalling of elective waiting time progress since the Government met its interim 18-week target in March.

‘We're going to have to operationalise much more of the waiting list around resources we put into resolving it in terms of the outpatient numbers as well as the elected care numbers if we're going to really address this in a way that that moves it from where we are now to a very different place,' he said.

‘That's a resource allocation question, it's a focus question, but I know there are people working on it as we speak.'

Lord Adebowale argued those waiting the longest in BAME, mental health and disadvantaged communities had to be prioritised in order to provide an equitable service and make the biggest impact.

‘Looking out, not just up'

With the fifth UK Prime Minister since 2019 set to take office and a newly installed health and social care secretary appointed in March, Lord Adebowale stressed the importance of the NHS ‘looking out, not just up'.

While expecting more of a change of emphasis rather than policy from the incoming PM, Lord Adebowale said the onus was on the NHS to deliver.

‘It's useful to know, but you're better off extending your own authority and influence than you are worried about who the prime minister or the secretary of state might be,' he commented.

The Health Bill

As a member of the House of Lords, the NHS Alliance chair will be closely scrutinising the Health Bill as it passes through Parliament.

‘I understand that about 23 of the 25 statutory duties of NHS England will move to the minister,' Lord Adebowale noted.

‘It's very important the Government recognises the need for a shift of authority from ministers and national bureaucracy to local leaders and all that being with the appropriate accountability. We've seen what happens when that doesn't happen.'

Lord Adebowale said ‘quite substantial reforms' to governance of trusts and ICBs were needed to ensure proper checks and balances, as well as support for local empowerment to deliver innovation and service improvement that speaks to local people.

He also warned of the danger of the NHS spending a year reorganising itself and ‘not doing the hard stuff'.

‘Restructuring is not change; it's just restructuring, he added. ‘I think we need to be really clear about form following function. But we need to make sure that people have the resource and the thinking time to do what's necessary and we don't lose focus.'

Lord Adebowale called for the Bill to focus on a ‘more empowered front line', along with a ‘real emphasis on strategic commissioning'.

‘Advanced Foundation Trusts should be part of that advanced strategic commissioning and there's a risk that none of it is really in there,' he added.

Concluding, Lord Adebowale called for an acceleration of social care reform.

‘We're not going to have a health system until we have a care system, and I think waiting until 2028 is too late,' he noted.

‘We need to be getting some interim measures in place and following some of the good practices already out there and getting it to scale before 2028.'