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Why wait? We can co-produce the future now.

The Nuffield Trust Policy Summit took place last week in Surrey. The key national players in healthcare got together with patient leaders, international figures and a smattering of NHS folk to discuss and debate where healthcare is going in the next decade and beyond. Full reports, video streams etc here http://www.nuffieldtrust.org.uk/summit/2013. I recommend the Jeremy Heywood one highly.

My conclusion – It’s up to local leaders in health, local government, the voluntary sector and the private sector to:

  • Be accountable for quality
  • Drive a value based system
  • That focuses on place and partnership
  • With patients and citizens being seen as assets not problems
  • Influenced by data and information
  • So that significant and rapid change can be effected.

 And there is no point waiting for permission, we can’t afford to wait.

 That’s good news for the arrangements we have in Leeds and it is part of the rationale for Leaders for Leeds.

 It also emphasises the importance of the Health and Wellbeing Board and associated arrangements – including the Transformation Board for health and Social Care and the Children’s Trust – and developments like the Leeds Innovation Health Hub, Transform Leeds and Co-Producing Leeds.

Why do I believe this? 

Ten things that stayed with me from last week.

  1. Francis Panel: Local leadership and value driven approaches were a consistent theme. “Francis is irrelevant to Boards” quoted Roy Lilley. Following Francis 1, Baby Peter, Maidstone, Bristol, 6 Lives report by Mencap…Boards should have acted….When it comes down to it, local organisations need to account for quality.
  2.  SofS: The NHS is “coasting” and meeting minimum standards rather than aspiring to excellence. The speech sparked significant comments which I won’t rehash. I think the speech gave permission to move away from just focusing on national standards and to concentrate on local measures and excellence. Good news given our work on social value and Outcome Based Approaches.
  3. Mori Research: Pride in the NHS, support for the NHS, satisfaction with the NHS has remained resilient and consistent, despite the issues of the last two years. “The NHS” is in our bones and part of the social fabric. Does this make it easier or more difficult to change? 
  4. Theme: we need to move away from seeing the NHS in isolation and the NHS as a single institution. The NHS is a complex system of organisations with different cultures and values. It is a powerhouse economically and is reliant on wider health issues.
  5. Theme: Change will only come through systems leaders working together. This includes patient leaders.
  6. Tim Kelsey: Patient power as a theme and using patients as assets was shown in various presentations. “Patientslikeus” a particularly striking example of using patient data for peer support and changing the dynamic for research. Tailored internet solutions from this organisation and many others was key.
  7.  Harkness Fellows: Learning from Advanced Care Organisations in the US. Some clear opportunities for CCGs to adopt this approach if they can overcome the barriers and issues that were found there – acceptance of risk, clinical leadership, new and better relationships with families are real, scale is less of an issue. 
  8. Reform of financial systems: Good evidence that reforming the financial incentives in systems helps. For example, in Germany, incentives around long term condition management have improved outcomes and reduced costs.
  9. Care outside hospital, prevention, patient power and assets. These were themes throughout. 70% care should be provided outside hospital according to a US healthcare leader. By comparison, community services in the UK were poorly understood and some of the usual disappointing prejudice were voiced.
  10. OECD: Have looked at countries systems in three tranches – liberal competition, gatekeeping with limited competition, gatekeeping with lots of competition. All systems have variation in value for money. All systems have similar opportunities for improvement – if you switch, no guarantee you will be more efficient and could be less. You may conclude it isn’t about the system you choose it’s about making it work locally.

“It’s Mainly Fiscal…” We have to change, the money will make us if nothing else

  1.  Nemat Shafik IMF: Health Spend increasing worldwide – driving force behind wider expenditure and a growing share of GDP.
  2. Nuffield Trust’s Anita Charlesworth: healthcare expenditure will need to take up a growing part of discretionary spend to be protected. This may not be possible.
  3. Credit rating agencies: without significant change, we will see credit ratings plummet. Healthcare changes are an economic necessity.
  4. OECD: Co-payments not efficient and could be damaging to healthcare. Some limited evidence that provider competition is beneficial. Labour market reform is the greatest area for potential development and savings in healthcare
  5. Panel: Strong sense from the floor that national pay is a good thing and “has saved us in our Hour of Need”. Appetite for local pay may be diminishing.

And another supporting view….

The World Economic Forum Report: stated there were three responses that would help the system in the coming years – information revolution; using patients as assets; a focus on place. All recurring themes during the summit – all parts of the Leeds landscape.

 

2 Responses

  1. Some great stuff to reflect on here Rob. In particular, point 9 about care outside hospital, prevention , patient power and assets. At a time when we are aiming to increase out of hospital care should we also be considering out of GP surgery care? – social prescribing to the third (social?) sector and some real thought given to taking prevention work and low level screening and consultation to the people. As in point 10, it’s about making it work locally for the people not the system – let’s embed proactive community doctors, prevention and well being teams in the social heart of our communities and cultures and really tackle some issues and health inequalities in a creative way without trying to drive everyone through a set of doors to a waiting room. Excellence is born from creativity not from clinging on to existing systems.

  2. Rob

    Hi Susie, you are right. We are doing some social prescribing as part of our integration work in the city. Some real potential for change and impact too.

    Rob