Health, wealth + stealth

Why the NHS reforms could be good for us

Health and sick care needs and how we pay for them are changing in the UK.  The current NHS reforms have and will continue to attract comment and counter comment from across the political spectrum.

During POPse! we will be asking if we need to go beyond the headlines and the grandstanding to consider if changing the NHS and how it is paid for could be good for you, good for me, good for us.

We’ll be looking at some of these key factors:

  • Demographic trends – an older population managing a range of complex long term conditions
  • People as constant users of the NHS and away from entry/cure/exit models of healthcare
  • How personalized budgets are already transforming health and social care and asking where could they go
  • The changing settings of care – as the left hand of the population defends hospitals, the right hand asks for care closer to home
  • Increasing focus on wellbeing and healthiness rather than sickness and ill heath
  • The rise of peer, social support and information networks
  • Growing interest in the “patient revolution” in delivery of health care solutions
  • What the creation of a (semi) open market for health (and sick care) provision already means
  • Increasing understanding of new models of payment for outcome
  • Increasing awareness of the potential for investment in health and wellbeing from both health providers and capital sources

This theme is being led by Sarah McGeehan, and you can follow its progress throughout the week by following the Health + Wealth category.

6 Responses to Health, wealth + stealth

  1. Should Andrew Langley ensure that all GP consortium are Social Enterprises to avoid the nightmare of fundholding GPs???

  2. popse says:

    Thanks for your comment Scott. Perhaps there should be some way of ensuring GP consortia have broader regulatory controls, but not sure making them be “social enterprises” (which we all know has no specific regulatory, constitutional or definitional value) is clever enough. But the answer (of course) is probably more complex than that. What are the minimum competency requirements for consortia? How can they quickly and effectively get up to speed on commissioning services? What happens to the services that they are unwilling, unable or uninterested in commissioning? One thing that does get lost sometimes is that GP practices are of course already independent businesses, so they are used to a level of autonomy. The other is that they do have an awesome level of understanding and insight on their communities health needs. Close to business practice and close to customers/clients – that sounds a bit like a social enterprise…….

    • Agreed social enterprise’s aren’t regulated but then again nor are limited companies. I do think however they can be more accountable i.e BenComs with members a consortium is a mere association of individuals in this case private businesses. I am talking about setting up a legal entity accountable to shakeholders both GP’s and Patients where the money is less likely to hemorrhage out !

  3. Shirley says:

    I am just completing a report for the Institute for Research and Innovation in Social Services (IRISS) about how service users and carers are using social networking for support, to connect and to find information about care services. (Due out in the next few weeks). There are an increasing number of resources available on the internet which include e-marketplaces, community websites, support groups, blogs, online training and peer support networks. The big challenge and question is how people needing care, carers and health and care professionals find and access all of these resources.

  4. The debate about the NHS is frustratingly binary. Public vs Private. Managers versus Doctors. Front-line services versus bureaucracy. Planning versus chaos. Gosplan versus the Wild West Discussion on the Lansley Bill, even among the better Parliamentarians and commentators, seems to sink to this level.

    Part of the problem is that the challenge of how we improve healthcare in the UK is fiendishly complex. Hardly anyone knows enough about all areas to really have a total grip on it. Furthermore, the issue of the NHS is related, as nowhere else, to larger ideas about national identity and the binding of our society.

    Reforming it, therefore is a hellish task. Some basic truths about the health service cannot be escaped from. Firstly, it is, globally speaking, relatively cheap. Secondly, it is unusual in that it is provided through taxation and is free at point of use. Insurance or payment haven’t, so far, entered the picture, unless you decide to opt-out altogether. Thirdly, as a system, the resources are allocated, for historic reasons largely, more to acute and hospital based services and less to community, primary and preventative services.

    Despite big political disagreements about means, there is some consensus on ends. We need to make the health service better at helping people help themselves to stay healthy, less about treating them in hospital when they are sick. Resources need, over time, to shift from one to the other. We also need health and social care to be less rigidly separated as the two needs tend to come together, particularly with an ageing population.

    There, however, it all breaks down and gets very binary. The way forward for the right is to create this change by splitting the purchase from provision of services and by opening up the market to any willing provide. Coupled with this, people should be allowed to both choose their provider and ‘top-up’ their service, like Fast Boarding, if they choose. This, goes the argument, drives efficiency, innovation and customer-focus. More bang for your buck.

    The argument from the left is that all of this disrupts an ecology of co-operation, integration and professional and public involvement which has developed since the formation of the NHS. Competition, they say, puts people who need to work together e.g. GPs and community services or community services and Foundation Trusts, into competition with each other. The patient – who is guided down ‘Pathways’ between primary, community and hospital care, will suffer as agencies fight over the funding and, inevitably, act in organisational self-interest, rather than that of the patient. Furthermore, there is huge fear over the consequences of co-payment and the idea of a ‘two-tier NHS’.

    As a self-confessed wooly liberal, I see both sides of the debate. I also work closely with health and use health services quite a bit. I can see both cases. What I do not doubt, however, is that no-change, is as unacceptable as some of the more far-reaching aspects of the Lansley Bill.

    I illustrate this with a personal story. One of my children is three and a half and has 20 words, about as many as a typical 18 month old baby. A year ago, he had none. We referred him to Speech Therapy. Apparently there is a waiting list. Then we got him seen. There was another delay. Then a couple of cancelled appointments. We get 1970s style letters telling us when we will be seen, inked in biro. No choice or quality of communication. The therapist herself is excellent but in the year since referring our child, he has been seen twice.

    Had I not the commitment I have to the NHS, I would have taken my child private six months ago. A queue for speech therapy at this age is just going to compound the problem – creating more work down the road – and possible education/ SEN needs.
    There is clearly a resource issue. But on top I sense a complacence too. This service is the only one funded by the NHS. Nobody else can do this and get NHS money. If I wanted my son’s notional share of the budget of this service to take to the market to buy a service from a speech therapist or practice I couldn’t have it. And there is no way I could augment this money with some of my own if I needed to, god forbid, because that would give my son some kind of bizarre advantage over some other child who may well also reach his fourth birthday unable to say more than a few words.

    Clearly, there is a need for some system-change here. I would be deeply surprised if the budget for speech therapy was such that if was not possible to work harder. While we need more planning to ensure under-funded areas do get funded, we also need more freedom to ensure that the money works harder so that people who need services benefit from some of the things we take for granted in other areas of life e.g. choice and the freedom to use our own share of public sector resources in the way we choose, even if this means adding some of our own.

    It is this kind of change that I am trying to encourage in my own work. I don’t think the NHS should be a free market. There are real dangers in losing control of the system to a profit motive, as in the US where spending is out of control and outcomes extremely poor. We need system-planning. But this doesn’t mean we can’t have a lot of providers and it doesn’t mean that users of the health service having to put up with a 1940s, nationalised industry approach to provision in which the forces which do drive forward innovation, quality and customer-services are systematically nullified.

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