Part of our response to the Labour Party Policy consultation June 2012
  1. Stop getting distracted by the NHS market. It has not yielded the benefits it was intended to over the last 20 years and an effective “commissioning function” remains as elusive as ever.
  2. Gather patient experience of their care
  3. Use national and international data to help inform the best pathways of care for all major conditions along the four stages of a continuum of prevention, diagnosis, treatment and aftercare.
  4. Ensure that the patient voice is integrated into every part of the planning and commissioning process with a formal legal duty that commissioners and providers need to show that they are responding (not just listening) to the populations they serve.
  5. National standards and a kite mark for a responsive organisation – Monitor has responsiveness as its remit – CQC monitors responsiveness.
  6. Providers need to demonstrate improving patient experience scores (not patient satisfaction). Money held back if not improving.
  7. Develop more 24/7 acute and community services, financed by moving cash from expensive capital and labour intensive DGH services to community forms of prevention and care
  8. Better information management which means reforming the data protection act for more joined up agency working; and/or equipping people with more easier to understand information to make better (more utilitarian) decisions. It’s time to bring the NHS into the age of Information Technology.  There has been talk about patient centred services for many years, but the experience of most is that we have to co-ordinate services ourselves.  Each institution operates in a vacuum, and knows little if anything of what happens outside its boundaries.
  9. We need to start with a recognition that we have moved from the situation in the 1940s when we still had a single relatively short life cycle with death shortly following retirement, if you managed to get that far.  Arguably there are now two distinct life periods:  early years and establishment as an adult up to around age 40 and now the second half of life with average life expectancy in 2011 for men at 78 and for women at 82.  We need to think more systematically about the second half of life which can be usefully split into four phases:
  • Preparation for active old age
  • Active old age
  • Vulnerable old age
  • Dependent old age

At present most of our thinking is focused on the vulnerable and dependent and relatively little thought is devoted to preparation for active old age and active old age.  No one wants to become vulnerable, lonely and dependent and end their life with an undignified hospital death, but this is the greatest fear for many older people. We should describe more fully what “a good death” looks like (pain free, with chosen ones around, in the place of our choice etc) and make the delivery of a good death  an important goal of the NHS.

  1. New Labour governments focused on two things, timely treatment and forward deployment of expertise. Timely treatment includes reduced waiting lists and times, faster attention in general practice and A&E departments, and fast tracking of patients with suspected cancer. These achievements may be eroded by the current government’s policy, and need to be defended. They show the advantages of central direction of the NHS.
  2. The best example of forward deployment of expertise is the change in the consultant contract to make senior staff more available, working closer to the front line. This has the potential to make treatment decisions more appropriate to the patient, and to offer better care, provided that a range of services are available to deliver the treatment options. So, for example, an individual seen in the A&E department may need investigation in a 24 hour medical assessment unit, observation and review in a 72 hour ward, admission for therapy to an acute ward, simple treatment that can be given at home, or short-term home-based care by a ‘hospital at home’ service. This planned segmentation and diversification of services is an alternative to a market-driven menu of choices.

There are two problems with this approach. There is resistance to it amongst hospital doctors, especially those in training, who are uncomfortable with the out-of-hours work that it entails. And we do not yet know how to restore the gatekeeper function of general practitioners, which is being so eroded by consumer pressure that referrals to all specialties are rising.

  1. To improve the patient experience, remind & reinforce health professionals’ existing codes of conduct & guidance on consent to treatment & confidentiality. All too often you hear of cases where informed consent was not the approach to offering and selecting treatment. I continue to be shocked by how easily many health professionals just gossip about patients thinking it’s ok if they don’t give the name OR merrily release information to relatives without ensuring there is consent for this, sometimes information will be given to others that has not been given to the patient. So reinforce respect!
  2. Ensuring any organisation or establishment providing healthcare is brought into the scope of the Care Quality Commission and registered. Ignore the flack they have taken, the registration process, the ensuring of best practice & evidence of this are good and sensible and what should be happening anyway. The inspectors are great – practical people who care about patients & are wise to their contradictions. This alone should ensure GP practices and hospitals are welcoming and staff are not permitted to be judgmental.
  3. Promote cultural change whereby this is put at the centre of health workers’ responsibilities along with safety and effectiveness. Remove barriers to this (e.g. the pressure under which many front line services work, and remove perverse targets. Promote the involvement of patients and their representatives in reviews of services with an obligation on service management to respond with action plans.
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3 Comments

  1. Graham Brack says:

    We don’t actually need a change in the consultant contract, just a change of attitude in acute Trusts and – potentially – the introduction of a new grade of primary care consultant. This could build upon the current GP with special interests, but it would be a community-based post contracted to the PCO or CCG. These consultants would visit GP practices on a sessional basis so you could have your Parkinson’s Disease or Diabetes managed by a consultant within your own surgery who sees you every 2-3 months. Since the appointments would be made by the practice, their gatekeeper role is restored. The acute Trust would then have to decide whether to volunteer some of their employee’s time, or share an appointment or, in some specialities, no longer provide because the community already has provision. My preference would be for the acute Trust to manage the service because the added flexibility should help them manage their costs. Instead of being a supplier of hospital services they become a supplier of specialised services, delivered in the most appropriate way.

  2. Rodney Kay-Kreizman says:

    I like the description of the 4 periods of retirement ! Prep.2Active 3Vulnerable 4.Good Death sorted out and organised as per wishes. Assuming that these phases are broadly about right- we all want to prolong the Active Element- elongate it and extend it as much as possible, hence we need a lot more emphasis on how e=we do this to active a meaningful flowering of humanity, via this active period -for all retiree’s and reduce the Vulnerable period to as short as possible, as this is full of potentially difficult times for many old people. Ideally we would want the 10% Prep period, and 80% active period – reducing Vulnerable period (3) to around approx 5% and the Death (4) obviously as short as possible ! Stroke Deaths then- interrupt our Active period, and really are a defeat for a pro-active NHS which is striving to reduce these unnecessay shortening of life and the real flowing of humanity that’s possible from the active period of retiree’s Active period.

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