Reflections on where we are now and where we need or would like to be
Context
• well recognised that NHS is great – commonwealth study said so twice;
• indeed, other countries look to us enviously
• but things have got more difficult since 2010
Our special relationship …
Some high level data – interesting but spurious?
Health Care System Performance Rankings
| AUS | CAN | FRA | GER | NETH | NZ | NOR | SWE | SWIZ | UK | US | |
| OVERALL RANKING | 2 | 9 | 10 | 8 | 3 | 4 | 4 | 6 | 6 | 1 | 11 |
| Care Process | 2 | 6 | 9 | 8 | 4 | 3 | 10 | 11 | 7 | 1 | 5 |
| Access | 4 | 10 | 9 | 2 | 1 | 7 | 5 | 6 | 8 | 3 | 11 |
| Administrative Efficiency | 1 | 6 | 11 | 6 | 9 | 2 | 4 | 5 | 8 | 3 | 10 |
| Equity | 7 | 9 | 10 | 6 | 2 | 8 | 5 | 3 | 4 | 1 | 11 |
| Health Care Outcomes | 1 | 9 | 5 | 8 | 6 | 7 | 3 | 2 | 4 | 10 | 11 |
Source: Commonwealth Fund analysis 2017
There are other challenges ….
Particularly workforce ones
- Demographic ‘time bombs’ in workforce…
- Average 25% vacancies in nursing workforce
- Impact of Brexit – already
- Quality and capacity/capability, too
- Related to funding and available workforce
You need sufficient activity to make it safe and effective so is there an inevitable need for reconfigurations
- A&E/EM
- Maternity and Paediatrics
- Cancer
- CVA & CHD
- Primary care
An interesting question – not least for socialists ….
- When we’re ill, we know where we’d rather be treated?
- We know which GP practice to join?
Or is this just like dilemmas over education:
- Selective education solution?
- Or, all local schools should be good schools?
Current ‘solution’ – STPs/ACOs&ACSs/Integrated Care Systems
- 44 STPs created by stealth – no legislation, and a reluctance to legislate
- A damaged brand
- Political opposition – P and p
Is it about
- Sustainability
- Quality
- Integration
Or is it about privatisation, USA style ACOs & ACSs / HMOs, Any willing provider etc.
Or, have we always had an element of private provision?
Some examples
- Worcestershire and Staffordshire maternity services?
- Birmingham’s health system?
- Coventry and Warwickshire
Coventry and Warwickshire has a combined population of just under 1 million
• 2/3 Clinical Commissioning Groups
• 4 NHS Provider Trusts
• 2 Social Care Local Authorities – Coventry City Council and Warwickshire County Council
• 4 Warwickshire District Councils
• Various system challenges
Concordat between Coventry and Warwickshire Health & Well Being Boards
• Ambition to develop sustainable services and bridge a funding gap of £267M by 2020/21
• Various work-streams, including:
- Stroke
- Maternity services
- A&E/EM
- Governance – political and public engagement
Coventry & Warwickshire Sustainability and Transformation Plan (Better Health, Better Care, Better Value)
Most recent announcement – Integrated Care Systems
Sustainability and Transformation Partnerships become Integrated Care Systems
- National contract
- Commissioners and providers encouraged to collaborate
- Still no statutory basis
- A&E targets loosened till 2019?
- Referral Time to Treat 52 weeks wait to be halved
- Cancer, Primary Care, Mental Health & Learning Disability
Things a Labour Government would need to sort …
- Increase spend as % of GDP – how much?
- (Strong) hypothecation?
- Introduce a national care service or simply implement a version of Dilnot?
- Scrap the internal market and public private partnerships?
- Eliminate differences between foundation trusts and non-foundation trusts?
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Very good article and important to debate. Spending has to increase but we also need cultural shift and also transformation and stop wasting public money. Today there is culture of bullying, harassment, poor team working which puts many patients at risk. There is acute work force crisis and 75,000 patients suffer more than 6 months or die due to ‘medical errors and nearly 80% of them are preventable. We need money for digital transformation and there are too many policies and doctors and nurses are struggling to cope with increasing demand. Complex sets of problem needs complex solution but we got to solve NHS as we all need safest and the best NHS. Integration is important for transformation as we have fragmented service and funding encourages more and more activity and money is wasted.
NHS needs good leaders who are kind, caring, compassionate and care for staff and create a culture of staff happiness and there is good governance and accountability for the way public money is spent.
The health of the nation is under constant threat as long as the people in charge of running the country and its services such as the NHS
remain in control.