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Major Conditions Strategy Announcement Divides Opinion

The Health Secretary's announcement to "bring things together" with a new Major Conditions Strategy has created a divide in opinion amongst major condition stakeholders.

In his announcement, Mr Barclay reiterated how the health and social care system faced "long-term challenges to ensure the public enjoy longer and healthier lives".

He highlighted how currently in England, 5.4 million people live with cardiovascular disease, around 8.6 million live with chronic respiratory disease, and 8.2 million people live with mental health issues, and emphasised that more and more people are living with "one or more major conditions".

People with diabetes are twice as likely to have depression, 9 in 10 dementia patients have another long-term condition, half of people with a heart or lung condition have musculoskeletal disorders, he highlighted.

The strategy, which will be developed in "consultation with NHS England and colleagues across government", will combine existing Government commitments on mental health, cancer, dementia, and health disparities "into a single, powerful strategy", Mr Barclay stated, with the goal of tackling major conditions - namely cancers, cardiovascular diseases, chronic respiratory diseases, dementia, mental ill health, and musculoskeletal disorders - that lead to people spending "more years in ill health".

To date, the health and care system had been "built in silos", often focused around specific diseases or organs, criticised Mr Barclay, adding that the new strategy will redirect the Government's health course by shifting away from the current approach to integrated, whole-person care, with the aim of alleviating pressure on the health system, increasing healthy life expectancy, and reducing ill-health related labour market inactivity. 

Mixed Reaction to New Strategy

Debbie Abrahams MP, Chair of the All-Party Parliamentary Group on Dementia, welcomed the "whole-system approach". She added that the proposed strategy "rightly recognises dementia" as one of the most significant long-term challenges for our health and social care system.

 However, she stressed that any strategy on dementia needed to be "suitably specific, bold and ambitious", and cautioned that: "Right now, we just don't have enough detail about the Major Conditions Strategy to know if this will be the case".

NHS Confederation's Policy Director, Dr Layla McCay said that health leaders will "welcome" the focus on integrated, whole-person care, as well as the emphasis on health and care services and local government working together. She added: "This strategy is welcomed given the rescinding of the health disparities White Paper, which will be absorbed by this new strategy."

Dementia organisations also felt cautiously encouraged by the new strategy.

"It's encouraging to see that the Government recognises dementia as one of the biggest health and care challenges of our time,” said Kate Lee, chief executive of the Alzheimer's Society. However, she underlined that it was vital that action on the "distinct challenges" of dementia was not lost within a broad strategy covering so many other serious health conditions. "We need a bold, ambitious plan for dementia and it remains to be seen whether this is the route for that to happen," she stressed.

Alzheimer’s Research UK welcomed new Government commitments to increase healthy life expectancy and reduce ill-health in the UK. "Today’s commitment from government to publish a Major Conditions Strategy is a step in the right direction, said Samantha Benham-Hermetz, director of policy and public affairs at Alzheimer's Research UK, and added that the Government's holistic approach is "welcome and sensible".

Concern Expressed Over New Direction

President of the Royal College of Psychiatrists, Dr Adrian James, thought that the strategy was right to focus on "shifting the healthcare model towards preserving good health", since early mental health interventions and preventative public health measures can "improve patient outcomes, put less pressure on A&E services, and improve the mental wellbeing of everyone", he highlighted.

"While we welcome the new strategy, we are disappointed that the Government has abandoned the cross-government mental health and wellbeing plan," he said.

Dr James was concerned that "by scrapping a plan that focuses purely on mental health" the Government was failing to address the "lack of parity between mental and physical health", and that patients will continue to experience "unequal" mental health support across the country.

Sarah Sweeney, interim chief executive at National Voices, also had mixed feelings.

"We are really pleased to hear the Secretary of State for Health and Social Care set out a compelling case for health and care bodies to break out of silos and work in a more person-centred way, joining up care around the individual," she said.

However, she was concerned that many health and care charities, who had been waiting for the launch of a cancer plan, a mental health plan, a dementia plan, and a disparities plan, would be worried about whether the new overarching strategy would "grasp and respond" in sufficient detail to the issues raised. "Many of our members will also wonder whether the issues they champion will be covered or not," she pointed out.

Disappointment Over 'Discarded' 10-Year Cancer Plan

However, some major condition supporters were far from pleased.

"To hear the 10-Year Cancer Plan has been discarded is hugely disappointing and a major downgrade from what was promised," grieved Gemma Peters, chief executive at Macmillan Cancer Support.

"Whilst some of the challenges facing cancer services affect the whole NHS, there are life threatening problems in cancer care that require special attention. It's vital that the specific issues facing cancer care aren't neglected," she beseeched.

Cancer Research UK's Chief Executive, Michelle Mitchell, also expressed disappointment with the announcement, particularly that the Government had "opted to publish a 'catch-all' major conditions strategy rather than the ambitious 10-year cancer plan they had originally promised".

She pointed out how evidence had shown "unequivocally" those countries which "enjoy the best outcomes" benefit from disease-specific strategies.

A "watered-down plan", she said, "risks failing to focus on the problem at hand". She urged ministers not to "further dilute" their commitment to cancer.

The YoungMinds mental health charity was also concerned by the move, which would "scrap a 10-year mental health plan promised last year". Tom Madders, director of campaigns at the charity, expressed consternation that the major conditions strategy wrapped mental health up with other health conditions, and was deeply concerned that this "golden opportunity to turn the tide on young people's mental health" will be missed. He added that the indicated further consultation would be "frustrating news" to the 14,000 young people who last year told the Government "loud and clear" what change was needed.

"Whilst we remain hopeful that this plan can deliver some changes in the short term, we are concerned that this one-size-fits-all strategy will fail to adequately address a rapidly escalating crisis in mental health," he added.

The 'Workforce Model Needs to Adapt': Barclay

The new strategy is said to centralise the state's key promises around mental health, cancer, dementia, and health inequalities, as well as aligning to the Government's Life Sciences Mission.

"This is about shifting our model towards preserving good health, and the early detection and treatment of diseases," explained Mr Barclay. To achieve this, "the workforce model needs to adapt, reflecting that the NHS is caring for patients with increasingly complex needs and with multiple long-term conditions," he said.

Greater emphasis on generalist medical skills to complement existing deep specialist expertise in the NHS was needed, Mr Barclay pointed out, supporting clinical professionals to "heal with whole person care".

Sarah Woolnough, chief executive of Asthma and Lung UK, expressed hope that the new strategy "listens to the experiences of those affected" and builds on the foundations NHS England has laid so far.

"It is hoped that the strategy will incorporate both a short and long-term vision beyond the political and financial cycles and is informed by meaningful public and professional engagement," said Dr Layla McCay.

Full Strategy Still Forthcoming

The Major Conditions Strategy will set out the standards patients should expect in the short term and over a 5-year timeframe, Mr Barclay explained, adding that he would "continue to be grateful for the thoughts and contributions from colleagues across the House, stakeholders, citizens, and industry".

"Strategies alone will not change outcomes. Delivery will require concerted effort from government and the NHS working in tandem, alongside social care, patient representatives, industry and partners across the health and care system," he said.

Ms Lee cautioned how the details of the strategy, or how it will work in practice, was still unknown. "We need a bold plan with real teeth to hold decision-makers to account on driving long-awaited improvements," she stressed.

Ms Benham-Hermetz expressed that the strategy must "meet the mark for everyone affected by dementia", and that the Government would be "held to account until it does".

Ms Peters added that people living with cancer "can't afford further delays". For this new plan to work, she said they need to be involved in its development from the start and must not be ignored.

"Developing a Major Conditions Strategy is an ambitious task," warned Ms Sweeney. She pointed out that the Government’s ambitions needed to be matched with sufficient funding, so that the people who deliver services on the ground have enough "breathing space" to develop new ways of working.

The Government plans to publish an interim report on the strategy in the summer.