The ten macro trends in the NHS (see Book 1) are creating many more chronic, out-of-hospital conditions and even ‘new’ conditions such as diabetes and dementia that make the boundary between a medical condition and a social condition meaningless. The imperative now is to give local leaders the authority and support to get on with it – and to protect them from the local interference that is often exercised by the national bodies and by central government.
The health and care system as currently designed cannot cope. Even before the pandemic, A&E visits were up 22 per cent over the last nine years. That’s almost 24 million attendances. This is largely because of the failure to tackle the growing problems of deteriorating health in poorer communities and the
needs of an ageing population.
The approach advocated here is based upon the principles of ‘equity,territorial justice and solidarity’. It calls for a radical re-fashioning of the structure of economic governance, based on a new federal constitution that would provide for a cohesive and balanced process of decentralisation, enabling national and regional governments to adopt inclusive models of development that promote more and better jobs, and target resources at the most disadvantaged areas and people.
Just how much power will be decentralised is uncertain, and the white paper announced in 2021 is ambiguous in that it doesn’t really do anything to integrate health and social care, and has centralising tendencies, such as provisions for greater political control from Westminster
This is the third in our series: The Best NHS?
