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What has the NHS Future Forum recommended?


The NHS Future Forum has today issued a raft of recommendations for the government on key areas affecting the nursing.

What is the NHS Future Forum?

The forum comprises around 60 members, most of whom are clinicians or NHS managers, and is chaired by leading GP professor Steve Field. It was originally set up by the government to provide independent advice on changes to the health bill, which it published in June last year.

It was then given a second set of health areas to investigate. These were education and training; integrated health and social care; information and the public’s health.

The NHS Future Forum listened to more than 11,000 people face to face at more than 300 events as well as engaging with people online, and also received more than 150 formal responses.

Reports on its findings were published today and are summarised below.


What are the forum’s key recommendations on public health?

The forum’s worksteam on the “public’s health” called for clinicians to broach health and wellbeing issues with patients at every opportunity, so that they “make every contact count”.

But the review group also warned that the NHS must first “put its own house in order” and make supporting staff to improve their health and wellbeing a “core principle” of every NHS organisation.

Summary of recommendations:

  • Every healthcare professional should use every contact with an individual to maintain or improve their mental and physical health and wellbeing where possible, whatever their specialty or the purpose of the contact
  • Health Education England, Public Health England and the NHS Commissioning Board should build a coalition with professional bodies to agree a programme of action for making every contact count
  • NHS organisations should design and implement a strategy for improving staff mental and physical health and wellbeing. They should report annually on their progress against this strategy and hold their chief executive, or other senior responsible officer or partner, to account against it
  • All providers of NHS-funded care should build the prevention of poor health and promotion of healthy living into their day-to-day business. NHS commissioners should ensure providers of NHS-funded care redesign their business in this way, using contracts and incentives to encourage providers to improve health and wellbeing and reduce health inequalities
  • NHS commissioners and providers of NHS-funded care should use partnerships with other local services to improve the health and wellbeing of communities that the NHS locally finds difficult to reach, providing training where appropriate
  • Healthcare professionals, NHS commissioners and providers of NHS-funded care should share learning about improving the public’s health and wellbeing and reducing health inequalities, and seek to learn from others

What did the government say in response?

The government said it will consult on a new responsibility for healthcare professionals to promote healthy living through their day-to-day contact with patients.


What are the forum’s key recommendations on education and training?

The future forum looked at the government’s reform plans for the planning and funding of workforce education and training, including the introduction of new bodies like Health Education England and local education and training boards.

The forum’s report drew attention to well publicised problems in nurse education, including “significant dropout rates and issues with basic skills such as numeracy”. It also criticised the provision of community placements for student nurses and an over-reliance on “virtual” training experiences.

It also said the “critical role” of ongoing development of staff was highlighted to it as of particular importance, and told of significant local variation in practice.

“With regard to continuing professional development, while there is good practice in places, this is not universal. Ongoing development needs to be recognised by staff and employers alike as necessary for the individual, and also critical for improving care,” it said.

Summary of recommendations:

  • The NMC should work with the RCN, RCM, Health Education England, higher education institutions and trusts to develop properly structured processes to support individual nurse and midwife development in post-qualification career pathways, ensuring support for clinical, managerial and specialist development
  • Local education and training boards should lead work with local partners to develop the quality of nurse and midwife training locally. This should be replicated for all clinical training programmes
  • The new clinical commissioning groups must work with local education and training boards to increase the provision of community placements for trainee nurses and midwives
  • DH should develop a system which rewards high quality education and training at all levels and for all professions, such as payment of a quality premium for teaching
  • The National Quality Board should “urgently” review continuing professional development
  • Trusts should have training funding withheld unless they hit standards for training provision
  • Development of a code of conduct and training standards for healthcare assistants welcome, but need for further checks and balances with the onus on employers to instigate further checks on those who are not on the voluntary register and monitoring by CQC
  • The DH should set out how it will embed training for team working, leadership development and the principles and values of the NHS Constitution at every level of the training and educational process

What did the government say in response?

Employers and professionals will have a greater say in developing the health workforce in the future, such as through local plans. And, for the first time, the government will introduce an outcomes framework for education and training.


What are the forum’s key recommendations on integration between health and social care?

The forum said too many people fall through gaps between services as they “traverse journeys of care”, and this lack of integration results daily in delays and duplication, wasted opportunities and patient harm.

“Given that patients with the most complex journeys are often those with the greatest need, poor integration places a significant and unnecessary burden on them, their families and the system,” it said.

Although the case was clear for more integrated care, the forum noted there were “many barriers and disincentives” that made it difficult to re-design care, for example a lack of shared leadership at local level between health and local authorities. It outlined a number of ways that it thought such barriers could be overcome as well as other suggested ways of driving integration between health and social care.

Summary of recommendations:

  • The entire health and social care system should embrace a definition of integration that truly puts the patient at the centre
  • NHS Commissioning Board should focus its commissioning guidance on supporting clinical commissioning groups to commission for people not specific diseases
  • NHS commissioners should ensure that every patient with long-term or complex needs has easy access to a named person or team who can act as the coordinating point for all of their care
  • Department of Health should urgently support the development of a new generation of patient reported experience measures that evaluate patients’ experiences across whole journeys of care
  • NHS Commissioning Board should introduce measures of service “interoperability” in contracts, including measures of the efficiency and reliability of admission and discharge process, patient understanding of care plans, and patient experience measures
  • Challenge the Academy of Medical Royal Colleges, the Royal College of Nursing and ADASS to develop a shared vision for how professional leadership can drive more integrated care for patients and to communicate this to their members
  • Professional bodies should gather evidence from their members regarding challenges and successes for clinicians, to be shared more widely. This may be supported by the development of “communities of practice” where clinical leaders can share ideas and best practices
  • Department of Health should commission new national clinical audits that span whole journeys of care for key patients groups such as frail older people

What did the government say in response?

The government fully accepts the need to orientate the whole health system around patients. So for the first time, patient experience of integrated care will be measured as part of the Outcomes Framework.


What are the forum’s key recommendations on information?

The NHS needs a culture change to drag itself out of the “information dark ages” and avoid reputational damage, according to the future forum.

The forum’s report on information said barriers to a more effective use of information are “more cultural than technological”. “What is needed more than anything is a change of mindset in the NHS,” it said.

Summary of recommendations:

  • The universal adoption of the NHS patient number across health and social care by 2013
  • A presumption in favour of hospital discharge summaries being made available to the GP and patient at the point of discharge, and for GP referral letters to be made available at the point of referral.
  • A review of information governance rules should be carried out during 2012
  • A clear contractual requirement for all NHS or social care providers to fully share their data electronically
  • A clear deadline in the current Parliament for putting all information on clinical outcomes into the public domain
  • Each NHS organisation should appoint a clinician responsible for organising information to support better care

What did the government say in response?

The government said it will consider the forum’s recommendation for discharge summaries being made available to GPs and patients at the point of discharge, as part of the Information Strategy published later this year.


Readers' comments (2)

  • Let National mean National: We all train the same; have the same range of opportunities post qualifiying with adequate support to perform as safely and effectively as possible, we all use the same equipment, we all use the same disciplinary systems to weed out non, or dangerous performers, we have the same attitude to risk, openness, care and to what is expected of us as NHS employees, serving and caring for the vulnerable members of our society. Weed out the primadonnas and the bullies. Wear the same uniform, use the same rules, get the chance to be appropriately supported to do the job which 99.9% of us love. Competition between hospitals may have encouraged standards to rise in some as money has become available but it's caused a system like a patchwork quilt. Any system that has lots of different and disparate facets will be weaker and prone to fail in time. Put us all back together, there's safety and strength in one heart, and one mind. Lastly, take away the endless paperwork and let us do our jobs.

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  • Anonymous | 15-Jan-2012 3:13 pm

    and the patients will get the same consistent quality care they are entitled to. this is what i have been saying all along and i totally agree with what you say.

    can't we all stand together and fight for a new framework instead of for the last 60 years just patching up old bits and pieces that have failed and the poor patients who have fallen between the cracks and where working conditions, staffing levels, training, salaries, and pensions have merely been left to fall by the wayside?

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