Filed Under (Charities, Creating public value, Reform of the NHS) by Paul on 16-09-2010
Thursday 16 September marks an event that will, in the long term, become one of the most important in the NHS. This is not a White Paper or a speech by the NHS Chief Executive but I think, in the next few years, it will change the terms of trade that make the NHS tick.
It will be important because it involves some of the most important members of the wider family of the NHS – the major charities – and they are doing something not only very new, but very vital.
Today ten major charities are publishing a progressive manifesto that argues for the remodeling of NHS health care. So much may appear so normal. The NHS is used to patient-led lobby groups demanding ever better new services for their members.
Within the architecture of a publicly run health service this is what they should be doing. But, over the years, the calls by patient groups for better services has become so familiar that it has been easy for the NHS to ignore them. The NHS reads their manifesto and wearily responds that “there are limited resources and that somebody needs to make the rationing decisions between these competing demands. We’re afraid we can’t take on any new expenditure”, etc. etc.
This response has the merit of truth. There is no more money and someone does have to decide how to spend limited resources. This generally means that such manifestos can be left on the shelf.
But this manifesto is very different from the norm. It does argue for much better patients’ outcomes and for much improved services, but it also demonstrates – on page after page – how this remodelling and the improving of health services will save money.
The document is based both upon the evidence of the financial benefits of an integrated system, and upon the research and evaluation conducted by all 10 organisations.
Their argument is that remodelling patient pathways is the only way that the NHS can ensure that it is a sustainable service. To achieve this the NHS will have to do three things.
1. It will have to model a complete patient pathway so that its entire cost can be understood and related to outputs and outcomes.
2. It will be no use making these changes piecemeal. You cannot save money by improving the spend on a bit of a pathway , it all has to be done at once.
3. The NHS has to stop talking about this and has to start commissioning new patient pathways from next April to scale. It is no good waiting around for this to happen until someone else takes responsibility to do it. Unless it happens now there will nothing but debt to hand over the GP commissioners.
The manifesto argues for five different aspects of remodeling. None of which is, in isolation new, but taken together and coming from patient organisations is all very new. They are,
1. Co-ordinate care
The argument for co-ordinating care to provide better outcomes for patients is hardly new. What is interesting is the examples they provide which show how much money can be saved by doing this. A University of York evaluation demonstrated that heart failure nurses reduced all cause admissions by an average of 35% with an average saving of £1826 per patients – after the costs of the nurse have been deducted.
2 Patients engaged in decisions about their care.
3 Supported self management.
4 Prevention, early diagnosis, and intervention
The “Time to Change” campaign led by Rethink and Mind is using social marketing techniques to challenge stigma around mental ill health. It has been estimated that if the campaign results in a 1 % increase in the number of people with depression accessing support services and gaining employment when their health improves then the economic benefits of the programme would outweigh the costs eight fold.
5 Emotional, psychological and practical support
Intellectually we know all this, but there is a new set of people on the block making this case that will not go away, and that are more ubiquitous than any QUIPP data base. This nagging pressure to improve and save money at the same time will be there for a long time.
In October Macmillan will be publishing an economic model which will provide the intellectual underpinning of this with more and more examples