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Reflecting on NHS reform - Sarah Eglington January 2014

As we approach the first anniversary of the NHS restructure and reform, we can take time to reflect on where we've come from, what we've achieved so far and where we are heading next. Has the reform been successful? The views from those involved are mixed and varied. Is the NHS more efficient, is it making cost-savings, is patient care improving? It's probably too soon to draw conclusions at this stage. Challenges and change are still ongoing. The new NHS, although ‘not-so-new' now, is still taking shape in parts as people adapt to the closures, mergers and establishment of new NHS organisations.

The main challenge for the health service going forward is the additional pressures it faces from the greater prevalence of long-term conditions, elevated costs and increase in demand. Currently 25% of over 60s have two or more long-term conditions and the number of over 80s is expected to increase by 100% by 2030. With £20bn efficiency savings expected to be achieved by 2020, and more cost-efficiencies likely beyond this date, it seems the difficult financial climate is set to continue for the foreseeable future. So how does the NHS plan to address this?

The key theme emerging as part of this reform is integration. Healthcare services need to better reflect the needs of our populations and better integration is deemed by many as the best way to meet these objectives and make the necessary savings. If a single patient pathway is to be achieved, then primary and secondary care need to work closer together to align the two patient systems currently in place. There is also the belief that capacity can be found, not just from increasing resource, but also by moving around ‘health' care that could be better served elsewhere in or outside of the ‘health' service. Closer integration between health and social care is planned with a £3.7bn integration fund allocated in 2013 to help deliver the integrated care programme.

Prevention, through various new initiatives, and the delivery of more care in the home-setting will play a key role in the early detection and improved management of long-term conditions (including self-management through technological advances where appropriate) as well as reducing admissions and readmissions in to secondary care. Seven-day working, tailored services and improved emergency care are also integral to addressing these challenges.

The reforms may not mean we're achieved everything set out at the start of this journey, but it's definitely taking us in the right direction.

<Taken from the Foreword of Binley's NHS Guide Winter_Spring 2014 edition>

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