Times Health Commission: A report into the state of health and social care in Britain today (5 February 2024)

Summary

Set up in January 2023, the Times Health Commission was a year-long projected established to consider the future of health and social care in England in the light of the pandemic, the growing pressure on budgets, the A&E crisis, rising waiting lists, health inequalities, obesity and the ageing population. Its recommendations are intended to be pragmatic, practical, deliverable and able to be potentially taken up by any political party or government, present or future. 

Content

The full list of recommendations in this report are as follows:

The scale of the problem

• Establish a Healthy Lives Committee empowered by a legally binding commitment to increase healthy life expectancy by five years in a decade and reduce health inequalities to encourage a long term approach with cross-party agreement.

Hospitals and waiting lists

• Tackle waiting lists by introducing a national programme of weekend high-intensity theatre (HIT) lists once a month in 50 hospitals to get through a week of planned operations in a day with two operating theatres working in parallel. Introduce seven-day-a week surgical hubs across the country to boost productivity. Invest in community diagnostic centres, this will require about £1.6 billion, partly for new facilities and partly for upgrading small sites to larger ones. Involving the private sector would minimise capital expenditure and accelerate the programme. It must also take full advantage of AI diagnostic tools as they become available.
• Create a user-friendly version of the Model Hospital website, which ranks all hospitals in the country on hundreds of key metrics covering everything from surgical outcomes to the cost of hospital food, for use by the public to drive up standards and give patients the tools to make an informed choice about their care.
• Over time the NHS should aim to separate “hot” and “cold” (acute and planned) care altogether as much as possible, creating specialist emergency centres and distinct elective hubs.
• More patients should be cared for at home with virtual wards, in which staff monitor their vital statistics remotely. Outpatient appointments must also be streamlined.

GPs and primary care

• Reform the GP contract to focus on wider health outcomes rather than box-ticking, ensure that patients get prompt appointments and restore continuity of care.
• Encourage more super-practices operating at scale and create a network of new community health centres with outpatient clinics, diagnostic services, pharmacists, mental health professionals, community nurses and physicians’ assistants working alongside family doctors. Operating within the community, these health centres could include diagnostic centres, outpatient clinics, family hubs, dentists, obesity support or frailty clinics as well as other services such as employment and housing advice, depending on local need.
• Pharmacists should be incentivised to do more prescribing, consultations and community care.
• The role of the GP as the “gatekeeper” to healthcare must evolve, with patients able to self-refer to a specialist for certain conditions such as dermatology and musculoskeletal problems.
• The barriers between primary and secondary care should be broken down. That could involve GPs being employed by hospitals or consultants doing outpatient appointments in the community.

Workforce and culture

• Write off student loans for doctors, nurses and midwives who stay in the NHS to improve retention and recruitment. Debt would be reduced by 30 per cent for those who stay three years, 70 per cent for seven years and 100 per cent for ten years. Student doctors should be eligible for full maintenance loans throughout their training.
• The health service across the board needs to become a much better employer in ways that go beyond pay settlements. This includes providing affordable and healthy staff canteens, night transport or parking, a comfortable staff room, private spaces for clinicians to decompress and somewhere to get a hot drink. There should be more on-site childcare and flexible work contracts to allow those with caring responsibilities to remain in the workforce.
• There must be a zero-tolerance approach to bullying, harassment, assault and racism, with prompt inquiries and action against those found guilty, however senior. Professional development and training must be offered at all levels to give staff a greater sense of career progression.
• The NHS workforce strategy must be updated and independently verified every two years, with the process overseen by the Healthy Lives Committee. It should include social care and software engineers as well as doctors and nurses. The increasingly important role of non-medics in community care and chronic disease management must also be recognised.
• There needs to be better training and career development for managers, the NHS Leadership Academy should be boosted and the Care Quality Commission’s “well-led” category for inspections broadened to include a detailed review of management practices. Medical training must be reformed to include more accelerated degrees and a greater emphasis on team-work and empathy. The private sector should be expected to support and fund medical training, including offering work placements to junior doctors and student nurses. The requirement for junior doctors to rotate all over the country must end to make it easier to balance work and family.

Patient safety

• Introduce a no-blame compensation scheme for medical errors with settlements determined according to need rather than through a lengthy court battle to ensure that families get the support they need more quickly and encourage the NHS to learn from mistakes.
• The promised introduction of “Martha’s rule”, named after Martha Mills, which would make it easier for families to insist on a second opinion, must come into force.
• There should be a review of the regulatory landscape with the aim of creating a simpler, more easily understood system to bring clarity for patients and the health service.
• The health ombudsman, who at present can only respond to complaints, should have the power to initiate investigations and ensure that the outcome of inquiries by other bodies are implemented in a timely fashion.

Science and technology

• Create a digital health account for all patients to unlock the benefits of technology, data and AI in the health and care system. The “patient passport”, accessed through the NHS app, would be used to book appointments, order prescriptions, view medical records, test results or referral letters, sign up for research with an opt-out system and connect hospitals, GP surgeries, pharmacists and social care. Tech providers wanting to work in the NHS must be required to guarantee interoperability with the unified patient record.
• Incentivise NHS staff to take part in research and put the case for research to their patients by giving 20 per cent of hospital consultants and other senior clinicians 20 per cent protected time for research. Thought should be given to how other NHS staff could be given protected time for research. The NHS must ensure that all staff have the basic IT skills they need to operate in the digital world and recruit data scientists and AI specialists to work alongside clinicians.
• A new British Data Authority to be created to reassure patients that privacy will be protected and deal with ethical concerns while allowing the advantages of data-sharing to be made available to ensure the best possible care. It would also be responsible for ensuring that a digital divide does not develop and ensure that everyone could access care. Introduce a “test first” rule for antibiotics where possible to reduce the number of prescriptions. This needs to go hand in hand with educating doctors and patients about the dangers of antibiotic resistance.
• The bureaucratic process for clinical trials and medical approvals should be speeded up.
• A new funding mechanism should be created for expensive curative therapies, allowing the NHS to spread the cost over a number of years if NICE approves the drug, based on long-term cost-benefit analysis so patients can benefit from the “new age of cures”.

Social care

• A new National Care System should be created giving everyone the right to appropriate support in a timely fashion. Equal but different from the NHS, it should be administered locally and delivered by a mixture of the public and private sectors but with national guidelines, registered providers, minimum standards for users and employment rights for workers.
• A statutory duty should be imposed on local authorities to provide information, advice and assistance about social care.
• Independent social care providers should receive a fair pay rate and be required to sign up to national standards on care quality, workforce and financial conduct in return for a licence to operate. Social care should be included in the NHS workforce plan and all future strategies should be integrated. Care workers need to be better paid, over time rising towards parity with NHS staff doing comparable roles. There should also be better career paths, routes to promotion and management.
• The pay caps for how much people can have in assets before they pay towards their social care should be higher and, in the future, rise with inflation to ensure that it keeps pace with the cost of living.
• The delayed government legislated cap on social care costs must now be introduced as a matter of urgency and the cap should apply to all care costs, including means tested council funding (reversing the government amendment that means that only private contributions should be counted).
• Those who need it must have the right to a social care assessment. Over time this should become a routine part of getting older Reablement programmes, with a strong link between health and social care, should be expanded around the country to reduce healthcare demand.
• Those born with a disability or who develop a care need before the age of 25 should automatically be entitled to free social care.
• There should also be more respite provision for unpaid carers and a review of the minimum income guarantee for disabled people to ensure it is fair and reasonable.
• A National Volunteer Service should be created for young people to work in care homes and visit the elderly or long-term disabled. All medical students should be expected to spend some time in a social care setting during their training to help to break down barriers between the two sectors.
• Developers must be encouraged to create more sheltered housing and intergenerational homes with a new planning class of “housing with care”.

Mental health

• Guarantee that all children and young people requiring mental health support can get access to treatment within four weeks for non-urgent referrals; within seven days when there is a risk of harm; and rapid follow up appointments for those who need help. Publish data on the waiting times for all mental health services.
• All children must have mental health support at school with access to specialist NHS teams. The government should undertake a national wellbeing survey in secondary schools that would focus attention on the importance of mental health and build a better understanding of how to create contented children.
• Mental health hubs across the country should offer drop-in facilities and early intervention, including peer-to-peer support.
• Reform of the Mental Health Act is long overdue. The proposals are ready to go and they must be implemented at the earliest opportunity.

Health inequalities

• Progress in narrowing health inequalities should be monitored by the new Healthy Lives Committee with clear annual targets for narrowing the gap between rich and poor.
• More money and power over health policy should be devolved to mayors and regions to stimulate innovation and incentivise local leaders to take stronger action and also more clearly link health budgets with healthy life expectancy.
• Sick pay should be reformed to ensure that people do not go to work when they are acutely ill and likely to be infectious. We propose that the earnings threshold should be abolished and the waiting period before sick pay is accessed be removed.
• There should be more community link workers in GP practices to help patients to cope with social issues affecting their health and wellbeing such as social isolation, money worries, unemployment, benefits or bereavement.
• There must be greater coordination between government agencies to identify problems early and stop the most vulnerable falling through the gaps. The patient passport that will connect the health and social care systems should also be linked with education data through the unique code given to children at birth.

Public health and obesity

• Tackle obesity by expanding the sugar tax, taxing salt, implementing a pre-watershed ban on junk food advertising and reducing cartoons on packaging to minimise children’s exposure to unhealthy food. There should be stricter controls on ultra-processed products, which are high in sugar or salt, but confuse shoppers with claims about being “organic” or “natural”.
• Expand free school meals to all children whose families are on universal credit, rolling out from the most deprived postcodes.
• More investment in school kitchens and chefs, with food and nutrition promoted in the classroom. All children must learn to cook basic recipes by the age of 11. Cookery and nutrition lessons should be inspected with the same rigour as maths or English and the government should pay for the ingredients. Ofsted should also monitor whether schools are meeting school food standards and those serving unhealthy lunches should not be able to get an “outstanding” grade.
• There must be a legal requirement on all public sector bodies — hospitals, prisons, care homes and army barracks as well as schools — to serve healthy food to promote the long-term health of the nation. Tougher action is also required on the promotion and marketing of unhealthy food. The pre-watershed television advertising ban, which was delayed, must be introduced as soon as possible and should also apply to digital platforms targeting young audiences including social media and YouTube. Sports sponsorship that promotes unhealthy food, alcohol or gambling should be banned.
• Businesses must be encouraged to do more to promote the health of their employees, with “H” for Health added to the Environmental Social and Corporate Governance (ESG) requirements for companies. Planning laws should be reformed to empower local authorities to reduce the prevalence of unhealthy food outlets, incentivise healthy food shops and minimise adverts for unhealthy products. Empty shops on neglected high streets should be offered to community groups to run exercise classes or social canteens, offering tasty, nutritious meals at affordable prices.
• Schools should be open to the community as much as possible over the holidays to improve access to low-cost exercise facilities for families. Private schools should be expected to participate in the scheme, offering up their playing fields, swimming pools and gyms in return for tax breaks.
• Smoking should be phased out and vapes must not be marketed to children with appealing colours and flavours.
• Minimum unit pricing for alcohol should be introduced in England.