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One given and five asks – NHS Reforms

On Tuesday I was asked to speak at a Parliamentary dinner with guests including a number of Peers from the House of Lords and backbench MPs. I was able to tell stories about the difference that community teams and services  make to people’s lives every day. All things I have witnessed first hand or been told by patients, carers and staff. As a “value based leader” this is something I reinforce with my team regularly. It is why we exist – to deliver the best possible care.

I then asked them to do two things as the regulations supporting the reforms go through.

Firstly – make it a given and always keep in mind that communities matter and most NHS services are delivered outside of a hospital. We need to look at both if we are to secure effective hospitals and better outcomes for local people.

Secondly, as the NHS reforms are implemented we need:

  1.  An improved financial regime which moves beyond the current arrangements where hospitals are paid for activity – an appropriate lever when hospital waiting times were the biggest issue in the NHS  – towards a system that rewards better outcomes for people. This would allow hospitals to be supported and services in communities to be more appropriately funded ;
  2. Regulators in their new roles (particularly Monitor) that are ready for “integrated” health and social care organisations and services that work with local charities and businesses too ;
  3. A clear definition of what it is “in the public interest” – Monitor has to promote integration over choice when it is in the public interest. Without such a definition, we will enter a legal minefield and be fearful of collaboration.
  4. Support for system leadership – we should all be accountable for making sure the system works as well as engaging in our NHS organisations.
  5. To capture and measure the ‘social value’ of high quality community services (not just the costs and activity) – the differences we make keep people functioning in communities or active or working and so on.

Leaders in Leeds are actively involved in each of these developments. We have a “year of care” tariff pilot going on across the City. System leadership is driven through the Health Hub, Medical Senate and opur programme itself. Social Value is part of a CIHM pilot with my organisation. And we lobbyon everything else.

Apologies for the technocratic nature of this piece – we work in a technocratic, rule based system! – and this is not meant to be a comprehensive set of issues to better manage reform. Otherewise I would talk of self supported care; caring; dignity; respect; diversity and difference; eliminating waste and so on. It is though a set of issues that need to be grasped, if we are to be successful