05.03.14
Oldham report makes ‘powerful case for change’
The government has to revolutionise care to make it less fragmented and more person-centred – but without reorganising the fundamental structure of the health and care system.
Sir John Oldham’s report from the Independent Commission on Whole Person Care, commissioned by the Labour Party, emphasises the need for ‘one person, one team, one system’.
He said: “Government leadership is needed to change how the organisations that provide care actually behave, rather than passing legislation to change how they are structured. Given most policy people agree with the problem – and agree what the new model of care should be – the failure to bring about this radical change comes from a failure to take on vested interests and fully implement the change.”
His report contains six key recommendations:
- Giving patients more power to co-ordinate their own care;
- Involving patient organisations like National Voices in policy generation;
- Collective commissioning plans rather than services commissioned for ‘body parts’;
- New incentives for doctors to provide whole-person care, rather than treating people as a series of diseases;
- The establishment of an internationally connected research centre on managing people with complex needs;
- A ‘national conversation’ on health and social care funding, as England “does not have the resources” to spread the ‘free at the point of need’ principle to social care.
Sir John said: “The current system does not serve people with multiple long terms conditions, frailty or disabilities well. Just as the last reorganisation of the structures of the NHS alongside the cuts in local government finance has failed to change that, we are also certain that a further NHS structural reorganisation will also fail to develop a coordinated care service. Relationships and culture trump structures. Our whole system recommendations may not be as visible as scrapping one set of organisations and creating another, but they tackle biases in the system that will make real differences to the day to day experiences of people using the health and care system. This is about service change, not structural change.”
Richard Humphries, assistant director of policy at The King's Fund, said: “The report makes a powerful case for change, adding further weight to calls for fundamental reform of health and social care to respond to the changing needs of patients and service-users. It is right to propose a new model of care with services co-ordinated around the needs of individuals, a stronger emphasis on prevention and more care provided outside hospital.
“We welcome the proposals to extend the use of single budgets for health and social care. Wisely, the report suggests an evolutionary approach which builds on existing structures, rather than advocating another major structural reorganisation.”
The medical royal colleges widely welcomed the commission’s report. Dr Peter Carter of the RCN said: “This is an important report which contains a number of promising recommendations which deserve serious consideration.We are pleased to see the recommendation that more emphasis is placed on multidisciplinary team working to enable all members of the health care team to fully contribute to a patient’s health and social care.”
Sir Richard Thompson, president of the Royal College of Physicians (RCP), said: “We welcome the report’s assertion that health and care services must be focused on the person, not the institution. Care should come to the patient, and that means care responsibilities that reach outside the hospital into the wider health community. Hospitals should no longer be seen as bricks and mortar, but instead as a skill base that can be deployed where it best meets patients’ needs.
“Delivering this holistic approach to health and care will require a more ‘generalist’ workforce. We need more doctors skilled in the diagnosis and management of older patients with multiple complex conditions.”
Jon Skewes, director for policy, employment relations and communications at the Royal College of Midwives, said: “The RCM has long championed the need for more effective and joined-up care between health and social care. Midwives and maternity services are often the first point of contact for vulnerable women with social problems such as domestic abuse and drug dependency, so are ideally placed to ensure the kind of joined up care this reports aims for.We welcome the report and look forward to contributing to and working towards its recommendations.”
Sir John’s full report can be found here.
NHE recently interviewed Sir John Oldham, and the upcoming March/April edition of the magazine contains coverage from a roundtable event organised by Integrating Care, which he also chairs.
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