2022 is set to be a pivotal year for the NHS. We will see a £10 billion cash injection from the elective care recovery plan and historic reorganisation under the Health and Care Bill.
However, for patients across the country, this will only work if there is a serious plan to address the NHS postcode lottery.
In its report into backlogs and waiting times published on Wednesday, the Public Affairs Committee called for a ‘national plan’ to address precisely this. For the Medical Technology Group this call came as no surprise. Since 2019, we’ve been campaigning through our Ration Watch programme to expose the stark regional difference in waiting times, recovery and access to treatment that has existed in our health service for decades.
Regional variation is something that runs deep through the heart of the NHS’s devolved management structures. Too often the level of care can be dependent on arbitrary decisions made by local commissioners conscious of budgets.
The result is a drastic regional variation in waiting times and access to pain saving, and occasionally life saving treatment. As the report pointed out, as of September 2021 patients in the worst-performing geographic areas were more than twice as likely as patients in the best-performing areas to have been waiting over 18 weeks for elective care.
‘Need NHS treatment? You’re better off up North!’, we announced with similar findings in October in which we found some of these worst performing areas in the Midlands and the South.
Unsurprisingly, the sardonic message of that headline is now a sensible government policy for tackling the backlog, unveiled by Sajid Javid at the Royal College of Physicians earlier this month. Travel and accommodation are being offered to those patients now at risk of life altering changes should they have to wait any longer for elective care.
But it shouldn’t have to be like this, and it certainly must not continue to be like this beyond this year of investment and reform. Regardless of where you live, you should be able to access the best of the NHS.
NHS England is right, different parts of the country have fared worse than others during the pandemic. But as the committee pointed out, this doesn’t explain the variation of poor performance of different Clinical Commissioning Groups (CCGs) prior to 2020. The pandemic has served to exacerbate rather than create the problem of regional difference.
By this summer, the Health and Care Bill, the biggest restructuring to the health service since 1948 will come into full effect. This, alongside the £10 billion of extra funding promised by the elective recovery plan represents a golden opportunity to address the drastic regional variation in NHS performance and services.
Under the Health and Care Bill – CCGs – responsible for services offered in a local area will be abolished and replaced by 42 Integrated Care Systems (ICSs) They will aim to provide a more collaborative approach to healthcare across Commissioners, providers and local authorities to plan and manage population health.
Using patient data, Commissioners will be able to home in on smaller geographical areas – even neighbourhoods – and plan their health policy accordingly.
In principle these are much welcomed changes – prioritising patient need and using data technology to efficiently manage medical interventions.
Yet we are also concerned about how these new ICSs will function and be held accountable. At present there is nothing compelling in the legislation to suggest that the same structure that has created this stark regional variation in waiting times and services will not continue.
Beyond the greatest reform in its history – the NHS postcode lottery could still be alive and well.
In light of this reform, what would a national plan to end this lottery look like? Firstly, there must be a proper framework to hold the ICSs to account. Sanctions exist for underperforming ICSs through the NHS System Oversight Framework – but in consultation with our network we’ve heard this is not working effectively. There needs to be a more robust system of appeal linked to legislation and funding if these ICSs underperform.
Secondly, there is concern that the new ICS commissioning budget pot will have to cover everything the previous CCGs did. Part of the branding for the Health and Care Bill is to remove the ‘competitive aspect’ of NHS commissioning, but unless these budgets are ring-fenced around specific services it is very likely this aspect, and the subsequent restrictions on treatments and services it encourages will remain.
Lastly, the patient voice must be represented in a meaningful way at ICS board level. If a patient is denied treatment, there must be clear recourse to action about where they can go and what they can do. Bussing patients around the country to the best performing ICSs cannot be the long-term solution. Patients must be able to hold ICSs accountable for serving their communities effectively.
End the postcode lottery and the better NHS promised beyond this great year of reform and investment can be achieved: the backlog defeated, improving waiting times, better commissioning and access to technology, greater diagnostic capacity, and patient need prioritised through a robust system of accountability.
Since 2019 we have heard stories up and down the country of patients let down by the NHS postcode lottery. In 2022, I am hopeful with a credible national plan we can begin to see a health service that delivers for all regardless of where they live.
