NHS leaders have broadly welcomed a review by former health secretary Patricia Hewitt which calls for a raft of NHS targets to be scrapped and a bigger focus on preventing ill health.
The study, commissioned by the Government, says a few targets help concentrate minds but having too many makes them less effective.
It comes as the NHS continues to miss major targets on A&E waits, ambulance response times and cancer waits and treatment times.
The review says adding new targets and initiatives and not being consistent with funding makes it impossible to plan new services and recruit staff, and wastes money and time.
The focus on prevention is crucial for long-term sustainability of both the NHS and more broadly to increase health and wellbeing of the population, and something for which we have long been advocating— Matthew Taylor, NHS Confederation
Ms Hewitt also says that some targets, such as those on A&E waits, leave less room for medics to use their clinical judgment.
An excessive focus on hitting targets by managers or NHS boards can lead to “gaming” of the targets and “disastrous neglect of patients themselves”, the review argues.
In her study, Ms Hewitt says ministers should consider significantly reducing the number of national targets, with no more than 10 national priorities.
There should also be more focus on outcomes to improve patient care.
Cutting waiting times for key surgery such as hip replacements and cataract operations should be matched by a focus on cutting waits for mental health treatment, the study says.
Local leaders running integrated care systems (ICSs) – which are partnerships of organisations that come together to plan and deliver joined-up health and care services – should be given more space and time to lead, according to the report.
On preventing ill health, the review calls for the share of total NHS budgets at ICS level going towards prevention to be increased by at least 1% over the next five years.
We hope to see the Government endorse and accept all of these recommendations, which are vital to the health and care system being able to meet the challenges and opportunities ahead— Matthew Taylor, NHS Confederation
The public health grant to local authorities should be increased after eight years of a real-terms squeeze on their funding.
This “shift upstream” towards preventative services is vital to prevent more older and increasingly unhealthy people entering hospitals that will never be “large or efficient enough to cope”, the review says.
Ms Hewitt says the NHS is, in practice, more of a national illness service than a national health service and called for rapid change.
The Government should also consider creating Citizen Health Accounts carrying people’s health information and data, to help people manage their own health and care, the review says.
Responding to the study, Matthew Taylor, chief executive of the NHS Confederation which represents NHS organisations, said: “I welcome Patricia’s review, and the recommendations she sets out.
“While the foundations for integrated care systems were set out in legislation last year, what we now need to see is a cultural and behavioural shift to make the best of these new structures – something this review will help to instigate.
“It is testament to the review team’s tenacity and hard work that a wide range of ICSs have been involved in the consultation process and reflects on the importance of seeing the health of the nation as more than the health service but as integral to a healthy and thriving society.
The emphasis on improvement over top-down performance management is essential and we hope the NHS at all levels will commit to the cultural shift necessary to bring this about— Sir Julian Hartley, NHS Providers
“The focus on prevention is crucial for long-term sustainability of both the NHS and more broadly to increase health and wellbeing of the population, and something for which we have long been advocating…
“We hope to see the Government endorse and accept all of these recommendations, which are vital to the health and care system being able to meet the challenges and opportunities ahead.”
Sir Julian Hartley, chief executive of NHS Providers, said: “At a time of great pressure across the health and care system, ensuring the right oversight, accountability and support for trusts and integrated care systems is critical.
“We welcome this report as it highlights how ICSs can help integrate care, forge partnerships within and beyond the NHS, and shift towards a preventative model of care.
“The emphasis on improvement over top-down performance management is essential and we hope the NHS at all levels will commit to the cultural shift necessary to bring this about.”
However, he said the review needs “more clarity on the responsibilities and accountabilities of different system players”.
A Department of Health and Social Care spokeswoman said ministers would respond to the review, adding: “Integrated care systems are an important part of the Government’s plan to deliver more joined up and effective health and care services and to cut waiting times for patients, one of the Prime Minister’s key priorities for 2023.”
