23.10.14
CCGs are the key to the future of out-of-hospital care
Source: National Health Executive Nov/Dec 2014
Health secretary Jeremy Hunt gave the keynote address on the final afternoon of the Best Practice Show, having made the trip to Birmingham after the conclusion of the Commons debate on Five Year Forward View from NHS England. Sam McCaffrey watched the speech.
Casting aside the podium used by other speakers at the Best Practice Show, Jeremy Hunt – ever the politician – took centre stage with a wireless mic. After telling a few jokes he addressed the Five Year Forward View, saying it had “fantastic vision” and that he fully endorsed its contents. He also said that it was GPs and the National Association of Primary Care (NAPC) that made it possible.
“I’ve always seen the NAPC as the innovators in the NHS: people at the forefront of wanting to do things differently, but true to the NHS values that we all believe in. I think you’ve been blazing a trail for a lot of ideas that are now becoming absolutely mainstream, and you’ve laid the ground in a way that has made today possible.”
He went on to lay out the government’s view for the future of the NHS. He started by saying how passionately he believes in what the NHS stands for, but he added that this “doesn’t mean that with an ageing population we don’t need to fundamentally change the model of care that we offer”.
“That model that started in 1948, it seems to me it was saying that if you’re a little bit ill, go and see your GP – and if you’re very ill, go to hospital. Then you’ll be cured and then you go home. But in an age where the population is growing older rapidly we need to think differently about the care we provide.”
The health secretary laid out the challenges: within two years, the number of people with three or more long-term conditions will rise to three million; a million people with dementia by the end of the decade; five million people over-80 by the end of the next decade.
“As you all know, and you’ve been working on the inside of the NHS for far longer than me, people with long-term conditions, older people, need a very different type of care. It’s care that is anchored in their home, in the residential care home, in the community rather than being anchored in a hospital,” he said.
He described CCGs as making a big difference in “unlocking” out-of-hospital care. “Now that we have GPs responsible for the bulk of NHS spending in local areas, they’re starting to look at priorities from a patients’ point of view and we’re starting to get some really extraordinary innovation happening across the country.”
Hunt wants CCGs to go further and called for them to become ‘Accountable Care Organisations’, responsible for all the care in the populations they look after – “Not just commissioning secondary care but, with the Better Care Fund, co-commissioning social care, with NHS England co-commissioning primary care, and with local authorities co-commissioning public health. Because I think we have to join this up and we have to think about healthcare much more holistically than has happened in the past.”
He added: “We really need to link up the public health campaigns conducted by national and local government with the work done by GPs and practice nurses in GP surgeries.
“I think CCGs can be the ‘spider in the centre of the web’, working closely with lots of other people, and the Better Care Fund is a fantastic example of the way that kind of innovation is starting to happen.”
He closed by talking about culture. In Hunt’s vision of the future, improving performance in the NHS will be driven by transparency of outcomes rather than targets. He pointed to the My NHS website and said the data about comparative performance of hospitals and local authorities it contains is “more open and more transparent than any healthcare system in the world”.
“I think as we become more comfortable with transparency we’ll be able to use fewer targets, because most of the time if people understand how well they’re performing compared to their peers, they want to learn.”
He added that changing culture is not just about personal care, but about personal control. He wants to see patients with long-term conditions taking responsibility for managing their own healthcare in a more active way, which will require clinicians to be more open with them about the decisions they take and give them more power over their own care plans.
“It is a change from the traditional relationship between doctor and patient, but it is a change that I think will help us make the NHS sustainable because the more people take responsibility for their own healthcare the healthier they are likely to be.”
More from the Best Practice Show here.
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