Patient choice and major expansion of personalised care at centre of NHS reform plan

·       Building on the Health and Care Bill and the success of the pandemic response, the Health and Social Care Secretary will today announce a new vision for NHS reform which puts patients first and gives greater choice

·       In his address, he will cover tackling COVID backlogs, dealing with the long-term challenges facing the NHS, and ensuring record investment has a lasting impact

·       New measures include a huge expansion of personalised care, enhancing the ‘right to choose’ and an increased role for the NHS App

Health and Social Care Secretary Sajid Javid will today set out his vision for long-term NHS reform, handing greater control and choice to patients over their care.

It comes as health services around the world face long-term challenges, from an ageing population to more people living with multiple health conditions.

From April the Health and Social Care Levy will come into force, raising almost £36 billion over the next three years for health and social care services, which the government is ensuring will be used as efficiently as possible as it tackles the COVID backlog and reforms adult social care.

To support this effort, Sajid Javid will deliver an address setting out the next steps for reform, with new policies to modernise the NHS, benefit patients and build on lessons learned during the pandemic focused on preventing ill-health, driving up performance and increasing patient choice.

This sets the direction of travel for reform and includes an expansion of personalised care and exploring extensions in the legal rights to personal health budgets, enhancing patients’ right to choose their own treatment and making the NHS App the front door to accessing personalised care.

Health and Social Care Secretary Sajid Javid is expected to say:

“Those are the long-term challenges the NHS must adapt to: changing demographics and disease; changing technology and expectations; and unsustainable finances.

“Taken together, it’s clear we were always going to come to a crossroads: a point where we must choose between endlessly putting in more and more money, or reforming how we do healthcare.

“There were major challenges before the pandemic. Pressures in social care were rising substantially too. But without the pandemic, the COVID backlogs, an even more stretched workforce and other new pressures, that choice might have been many years down the line. The shock of COVID and the urgent need for recovery has brought us to this crossroads right now.

“I choose reform.”

Some of the measures being considered to empower and give patients and their families more say over their own care include:  

• Enhancing patients’ right to choose: Patients will be offered more choice and know average waiting times at the point of referral. Those waiting the longest will be contacted by the NHS to be given the opportunity to change provider to reduce their wait. The NHS will support patients with travel costs if feasible and will engage with the independent sector so all options available. By the end of this year, all patients that have been waiting for 18 months or more will be contacted to discuss the choices they have about changing provider.
• Expanding the number of people benefitting from personalised care: Over 4 million people are set to benefit by 2024 from the expansion of personalised care, empowering people to manage their health conditions and have more choice and control over their care. This can include social prescribing, care and support plans and personal health budgets. This expansion follows the NHS exceeding its target of 2.5 million people two years earlier than planned.
• Expanding personal health budgets: Going beyond the existing target of 200,000 people benefitting from a personal health budget by 2024, giving people and their carers more choice and control over their own care. In addition, exploring the introduction of legal rights to a joint funded health and social care budget.
• Increasing use of the NHS App to help people manage their health: The NHS has a target of 75% of all adults in England using the NHS app by March 2024, making it easier for people to book appointments, communicate with their health provider, see test results and get advice to manage their health and wellbeing  As part of this, the first ever comprehensive Digital Health Plan will be published in the spring. It builds on initiatives from the pandemic, such as virtual wards where COVID-19 patients were monitored at home with their loved ones, which the NHS aims to expand across the country.
• Rolling out electronic records to 90% of trusts by December 2023 and 80% of social care providers by March 2024: The increased use of electronic records will allow staff to know immediately which doctors a patient has already seen, which medication they are on, and which conditions they have already been diagnosed with. Currently 40% of social care providers have introduced electronic records and around 79% of NHS trusts.
• Raising awareness of the ‘Shared Lives’ scheme: The scheme matches someone who needs care, for example adults with learning disabilities, mental health problems or other needs, with an approved carer and sees them living or staying with them. To date, 9,000 people are supported by the scheme in England and the Social Care White Paper announced up to £30 million to help embed innovations like this.

Health and Social Care Secretary Sajid Javid is expected to go on to say:

“The ideas behind personalisation go all the way back to Hippocrates, but in recent years, personalisation has taken on a new life: from making use of our new ‘family hub’ service, to taking a test at home for COVID and uploading the result.

“We know that when healthcare is personalised – built around the person and their family – it works better. It’s not just more efficient, it’s more effective too: with more diseases prevented and better medical interventions.”

The government and NHS will review and improve the quality of data on waiting times to support GPs to offer more choice, including in the private sector, and work with the Royal College of GPs and GP members to identify additional ways patients can be supported. Alongside this, there will be a communications campaign so patients are fully informed of their options. Over time the NHS will also use cutting-edge insights from behavioural science to further improve patient experience of choice and waiting times.

Personalised care is based on what matters to people and their individual strengths and needs. For example, through social prescribing link workers develop tailored plans with people and connect them to local groups and support services.

Personal health budgets can be used by anyone where a clinician believes it would be beneficial. Certain groups with complex conditions, such as adults and children receiving NHS continuing healthcare, have a legal right to a personal health budget.

In order to secure a personal health budget, clinicians must determine whether it is appropriate and a clear set of criteria must be met. The decision on how much to allocate, and the flexibility of spending is based on clinical expertise and could include spending on things like a new wheelchair with additional features that can enable people to live more independently.

For those who are able to have a personal health budget, the NHS team will work with them to develop a personalised care and support plan. The plan will set out the individual’s health and wellbeing needs, the health outcome they want to achieve, the amount of money in the budget and how it will be spent.

The choice and control they offer enables patients, and their carers and loved ones, to use funding to meet their individual needs and manage their own care and support more effectively.

Personal health budgets can deliver a range of benefits including improving people’s physical and mental wellbeing and their sense of autonomy and control. They can also have the potential to reduce pressure on high-cost NHS services such as inpatient care.

An integrated budget is where the budget includes funding from both the local authority and the NHS. This could be for health and social care needs and where appropriate include education funding. Joint funded health and social care budgets aim to put in place a seamless approach to care, so that people and their families have the same experience of care and support, regardless of whether their care is funded by the local authority or the NHS.

The vision for reform follows the publication of the NHS’s Delivery Plan to Tackle the COVID Backlog, and the government’s Integration White Paper which will help achieve more joined up health and social care services to improve care for all and value for money.

The Health and Social Care Secretary’s vision also builds on the foundations in the Health and Care Bill which is currently passing through Parliament, and when passed will deliver a health and social care system that is more integrated, less bureaucratic and more accountable in the wake of the pandemic.