Monday, 9 August 2010

Saving the NHS

Interesting to see the comments by Prof Steve Field, Chair of the Royal College of GPs, in yesterday’s Observer. He argues that much more responsibility for good health needs to lie with the general public and strongly criticises “reckless” behaviour such as excessive drinking, smoking and poor diets.

He also makes clear though that this personal responsibility does not exist in a vacuum, nor is it the whole solution, and that the NHS and government must be there to support and encourage better decisions.

It is interesting because the new government somehow needs to find a way to make conversations about spending less money on healthcare politically acceptable. The Tories knew that any suspicion of being hostile to the NHS or seeking to cut health budgets would be electorally fatal. The Coalition has maintained the promise to ring fence health spending, even though the Lib-Dems did not match that promise during the campaign.

Now I have absolutely no desire for government to spend less on healthcare for its own sake. But as I have argued here before, the focus in our popular narrative on protecting acute care above all else means that we neglect investing in community care and preventative interventions which crucially both cost less money and can stop people getting acutely ill in the first place. The kind of behaviour change which Prof Field speaks of should be our strength as a sector.

The conversation which government needs to stimulate therefore is not how to cut money from the NHS, but rather how can health care and public health be delivered in a way which focuses less on institutions and more on good outcomes for the public. As we know, seeking to close a hospital is met with placards and protests. Yet there no longer being a need for that hospital could be met with celebration.

The third sector has an absolutely key role to play in all of this. Recently Paul Corrigan wrote an outstanding pamphlet for us on how the third sector will be the catalyst for a transformation of the way in which healthcare is delivered through revolutionising the business model and changing the way in which value in healthcare is conceived. The public themselves can add value to their own healthcare, not just by adopting healthier behaviour but by learning more about the long term conditions from which they may suffer. His argument is purely an economic one – although with a clear moral obligation.

I can’t recommend it strongly enough. It will change the way you think about the healthcare sector. You can download it here (you just need to enter your email address to see it).

So how do we get there? This round of NHS reform is going to be crucial for the third sector. GP commissioning consortia could be a huge opportunity for third sector organisations to have a greater role in both provision and in working with clinicians to commission the right interventions for particular demographic groups. Details of the White Paper are currently open for consultation and the ACEVO policy team is working furiously with members to respond.

But it will be a difficult challenge. A colleague of mine was recently hosting a roundtable with GPs to talk about how the third sector could play a significant role in markets for patients with personal health budgets. While very enthusiastic about what the third sector could offer in their local area they ended the meeting asking whether there were in fact any third sector organisations in that area!

That dialogue must be quickly formed if we stand any chance of encouraging behaviour change in the general public to live healthier lifestyles, or create a health service which can respond to the challenges it now faces.

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