For some time it has been apparent that the second era of the NHS is coming to an end. The era of markets and competition is over. What comes next is up for discussion and the progressive left has to have a narrative.

For now the basis of a universal, comprehensive health care system funded out of taxation will remain. The NHS will no longer be truly national and it will somehow be melded with a means tested social care approach. How Public Health gets into the picture and how the whole links to other parts of the public sector such as housing is unclear.

Neither the health part nor all of publicly funded care will be wholly publicly provided but then it never has been. What settlement is reached with the private and voluntary sectors is an issue, but the more important issue is how the system is held accountable, given it will not be a market

The big questions are then:-

  • How do we as individual users of the system gain our proper role in shared decision making about our own care?
  • And how do we as collective owners of the system influence and hold to account those who make decisions on our behalf about service design, funding, allocation of resources and priories?

We also know that devolution and decentralisation and all kinds of alternative local models for a care system are being actively progressed challenging the N in NHS. Models for integration will change the H for Health into a C for Care.

For those on the left the fundamental issue is how the care system works within the overall public sector to increase wellbeing in a way that reduces inequality and supports redistribution.

The current social care provision is very poor and it is widely acknowledged that the NHS has unacceptable variations in care outcomes, lags behind the best in the world for some outcomes, is fragmented and poorly connected to other services. As mentioned above the NHS lacks any credible accountability and involvement mechanisms.

So we don’t want a care system that stands still, we want improvement and development.

There is a huge consensus that another whole system to down reorganisation is not the way. Even local energy expended on mergers or takeovers is a diversion. So far as possible current structures are kept and made to work better together. The same is true with gu8iance and regulations, far better to create an enabling framework and remove obstacles than try to direct everything from the top down.

This really comes down to improving relationships.

What can be done to help improve the key relationships that inhibit developing a better more responsive and connected care service?

What can be done to improve the relationships:-

  • Between staff and their management
  • Between clinical tribes
  • Between patients and clinicians
  • Between primary care clinicians and secondary care.
  • Between Councillors and NHS managers
  • Between ‘Providers’ and ‘Planners’
  • Between ‘Planners’ and local communities
  • Between Public Health specialists and everything else

Or even

  • Between GPs and schools?

And so on.

The excellent Oldham Commission set out some very good ideas about bringing the training and development of staff into a better system. We have had recent confirmation of how inequality is still rife within the NHS and could be addressed. We are beginning to see with some Vanguards how managers from Councils and NHS Bodies are having to work together. We see also integrated provider organisations being developed which break the old boundaries. And so on.

But it’s all a bit ad hoc and lame and lacks any strategy to drive it all forward. And whenever there is a discussion about the topic it usually descends very rapidly into arguments structures.

Anyone got any ideas?

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