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Baby few minutes after the birth
Giving every child a strong start in life is morally right, economic common sense and good for the NHS. Photograph: Getty Images
Giving every child a strong start in life is morally right, economic common sense and good for the NHS. Photograph: Getty Images

Health reform should start by looking at the first and last days of life

This article is more than 6 years old

Report proposes a new approach to primary care, putting people at the heart of everything the NHS does

With ever-growing pressures from funding, staff shortages, demand and targets, is it possible to bring joy back to the healthcare workforce and put patients at the centre of their care? A group of healthcare leaders think it is.

Frustrated by the difficulties of getting back to what really matters in healthcare but convinced there was a way forward, two dozen people from health and social care got together as the Industry Coalition Group to get some fresh thinking into discussions around NHS reform. Healthcare at Home put some funding in and brought the group together; Mike Bell, chair of Croydon health services NHS trust, led the discussions, and the result was the 2,000 Days Project, launched at the King’s Fund and Cambridge Health Network this week. In the spirit of full disclosure, I should add that I wrote the report.

The 2,000 days refers to the first and last 1,000 days of our lives. Maternity and infancy profoundly affect our life chances and lifetime consumption of healthcare. Giving every child a strong start is morally right, economic common sense and good for the NHS.

The last 1,000 days crystallise the issues of choice and empowerment; how care can maximise the quality of life, rather than simply its length, and how to get the most value from healthcare resources.

The report argues for a new approach to primary care, called the principal care service. It aims to put people at the heart of everything the NHS does, bring joy and fulfilment back to the workplace, and create an environment in which improvement and innovation thrive.

Clinical commissioning groups and local authorities would commission it together. Alongside health and social care would be pastoral services such as debt, housing, employment, sexual health and addiction advice – supporting mental and physical health. This would reduce pressure on GPs to find medical solutions for social issues.

There would be a single, easy to use digital interface. Digital triage would direct people to the appropriate service and promote self-help at every opportunity.

Crucially, services such as physiotherapy and talking therapies would be accessed directly, without the need for a GP referral. Direct access to sexual health services already shows this works.

Online and face-to-face services would be integrated, so service users could access services via smartphone or computer. This would include, for example, GP consultations, computer-based psychological therapies, mental health crisis support and sexual health advice.

Every contact would maximise self-care, such as home visitors supporting physical activity and mothers being supported in breastfeeding their children. Signposting to non-medical interventions – such as exercise and social contact – would be key.

GPs would be at the centre of the service, managing, providing and coordinating care. Free from directing traffic to services now accessed directly, and with a greater network of social support for service users, GPs would be able to dedicate more time to managing the care of people with complex needs who need them most.

For the first 1,000 days, there would be a strong focus on maternal mental and physical health – as already happens in Croydon. This includes a concerted effort to promote parent-child bonding and identify problems such as postnatal depression early.

For the end of our lives, principal care focuses on allowing us to live the life we want and have the death we want. Instead of care becoming the health and safety police, keeping people safe, we would have support to stay active. People and carers would have greater help to stay living at home and – if they wish – to die there.

Everyone involved in the 2,000 Days Project believes that focusing on what really matters – person-centred, community-based care delivered by staff allowed to do the jobs for which they trained, taking advantage of cheap consumer technology where possible – is the best hope for a health and care service that feels close to being overwhelmed.

Now the search is on to find two or three areas willing to give the principal care approach a try.

  • Richard Vize is a public policy commentator and analyst

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