Wednesday, 22 February 2012

Excellent Article on NHS Reforms

I think this article from Stephen Bubb Chief Executive of the Association of Chief Executives of Voluntary Organisations (ACEVO), published in the Times today, is an excellent summary as to why the coming NHS reforms are so important:

‘When facing great political turmoil, Catherine the Great once said, "a great wind is blowing and that gives you either a headache or imagination". The current debate on the Health Bill has certainly given the Government a headache. But is our political class responding to the challenges facing our health and social care system with sufficient imagination?

When I was writing the report for the Government on choice and competition as part of the Health Bill's listening exercise, I was struck by the fact that there is a great deal more consensus on the challenges facing health and social care provision in this country than the furore over the Health Bill would suggest.

Crucially, there remains common acceptance by all major political parties of the basic principle of a universal national health service, provided free at the point of use. Furthermore, there is also growing agreement that the current system cannot cope with the growing health needs of a changing population.

There are now 18 million people suffering from long-term health conditions in the UK. That number is growing. 21% of the population are now aged over 60. That proportion is growing. Medical advances, lifestyle changes and demographic shifts are growing demand for NHS services, but financial resources are limited.

Almost everyone agrees we have a problem when over 70 % of NHS funding is spent on treating long term conditions, usually in the most inefficient way there is: in hospital. And almost everyone agrees that if the NHS is to cope with these pressures it must shift resources towards preventative, patient led community based services which treat chronic conditions far more effectively and which act to pre-empt acute crises of ill health.

Might I also suggest that the majority of observers agree that to carry out this change effectively, the NHS must allow new providers with new ideas to break the bureaucratic stranglehold on service delivery. When in government, Labour's Andy Burnham- now shadow health secretary- spoke of his vision for a preventative and people-centred NHS which would allow the maximum freedom for local innovation. Much the same thing can be heard from Health Secretary Andrew Lansley today. And yet, to judge by the reaction that his bill has provoked, one would think that a centralised, bureaucratic and too often inefficient model of healthcare delivery is politically sacred and permanently untouchable.

Similar challenges face our increasingly broken system of social care provision; a problem which, as I suggested at the Health Summit at No. 10 on Monday, we have yet to tackle effectively. Successive governments have failed to address the issue of the growing numbers of frail elderly who are increasingly being treated (often badly) in hospital beds, when they should be receiving care at home or in high-quality residential homes. Due to the growing proportion of elderly members of the population, the system is creaking at the seams. We desperately need a political consensus to reform our social care system, and the current acrimonious debate on health is distracting attention from that necessity, as well as from the way forward proposed by the independent Dilnot Commission on social care provision.

What frustrates many of my members, the leaders of the country's charities and social enterprises, is that despite the consensus on both problems and solutions, the debate over reform focuses on the phantom of "privatisation".

We know that the majority of people who die in hospital want to be cared for at home or in a hospice, yet we fail to commission the charities that provide that care. This is a shocking waste. Many of the country's charities have a deep understanding of the problems that people and communities face, and do a superb job of providing vital community-based health care and much-needed assistance for patients in their homes. They know how to help patients to manage their own conditions. In such cases, supporting patients to manage their conditions through lifestyle, diet and exercise, is just as valuable as the work that clinicians do. Yet we continually fail to commission those charities that have the ability and drive to support patients in this way.

I fervently hope that our politicians can build on the common ground that exists on the need for health and social care reform, and find a way to take it forward. The positions of the Coalition and the Opposition differ more in emphasis than in substance. The Government is right to stress the importance of an open public service environment in which new providers can compete, innovate and offer users a real choice. However, it should place more emphasis on the end to which competition is the means: meaningful patient choice and user-led, community-based services that focus on effective intervention and prevention. The opposition, for its part, is right to emphasise the need for integrated, preventative services, but has forgotten that competition is a necessary first step to making that possible.

When we face the toxic combination of dramatic increases in demand for health care and dwindling resources, we must ask that the political parties focus on how the existing model can change to deliver effective health and social care that is based in the community rather than the hospital, is focused on prevention rather than cure, and places power and choice in the hands of citizens rather than providers. The change we need will never be achieved by leaving the current bureaucratic centralised systems in place. So how do we encourage the innovators with the imagination to do things differently?'

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