01.10.12
Being the change
Source: National Health Executive Sept/Oct 2012
A sequence of major reports, speeches and interviews have urged radical transformation of the basic model of UK healthcare to equip it for the future.
The King’s Fund, Royal College of Physicians and NHS Confederation are among the organisations that have spelt out the need for change in both the short and long term, focused on the acute sector, though with different emphasis.
The long-term argument is familiar: that the provider sector needs to be re-balanced to reflect changes in demography and health needs, away from an emphasis on one-off acute healthcare incidents, and towards community and home management of multiple long-term conditions, and especially towards public health and preventative healthcare. Acute units would become more specialised and there would be fewer of them, while the primary and community sectors would take a bigger role.
The RCP’s point is that acute capacity is already stretched, with a reduction in beds and staff but increase in patient demand – an acute crisis, you could even say, as opposed to the long-term condition management flagged up as the issue by The King’s Fund.
The politics of this are also wellrehearsed. Big increases in acute capacity to extend the current model would probably be politically popular, but financially untenable and of doubtful long-term clinical good for many patients.
On the other hand, a more radical transformation would also have short-term financial costs, but in the longer term be more realistic and with luck improve patient outcomes.
The greater problem is political: such changes are called radical for a reason, and would by definition result in the closure of some hospital units and entire hospitals. Even if overall capacity increased and the evidence suggested such reconfiguration would improve outcomes, it is politically a very tough sell that some localities should ‘suffer’ to make things better for everyone.
The public health challenges are scarcely less difficult, and again rely on spending more money now to try to cut the amount we’ll need to spend in the future.
This is further complicated, of course, by the current structural reforms. Patients and the public may well ask, if the Health & Social Care Act is not the answer to such a big question about the future of the NHS as that raised by The King’s Fund, then what question precisely was it the answer to?
More prevention would mean less treatment – good for the NHS, good for the public. Integrated care would be good for the NHS, and good for the patient. But these things are incredibly difficult, and we’ll need vision and leadership to get there. Can anyone see ministers riding into battle on this any time soon?
Or does the logic of the Government’s reforms as originally understood – more power for clinicians, less for politicians and administrators – mean it is now up to the NHS itself to reform itself?
Adam Hewitt - Editor
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