Change is inevitable, but more confusion and conflict is not
The last thing most HSJ readers want to hear about is the prospect of further change. Unfortunately the nature of these reforms almost guarantees it.
Too many rushed decisions, political deals and attempts at currying favour have produced a system full of conflicting incentives and mixed messages. A rethink is inevitable.
But for once let us look on the bright side. This week, HSJ highlights how fresh thinking from inside and outside the sector may unlock us from the circular arguments we too often find ourselves in.
We speak to Clayton M Christensen, author of the seminal The Innovator’s Dilemma and its health focused sequel, The Innovator’s Prescription. Many will be surprised to find the US business guru espousing the importance of integrated care and questioning the value of the purchaser-provider split. But his most important message is how innovation is likely to be found outside conventional models of care in which, as he says, the equation that better quality requires higher cost is so firmly embedded.
Monitor’s Kate Hall shows how the ideas of another Harvard professor, Michael Porter, are already being put to use by the NHS. His concept of improving healthcare using shared values is a powerful way of breaking down historical barriers.
Should all of these Boston-born concepts prove a little rich, then read how the Whittington Hospital Trust in north London is taking radical action to dismantle the barriers to developing integrated care. Many have complained that the current payment mechanisms complicate integration ambitions, so the Whittington is offering to provide all of its services within one bundled tariff.
It will not be the last provider to do this, nor the last to have a local GP leading its vision.
All of this gives reason to hope that the rethink – whenever it comes – will be based on sound theory and truly justify the tags “bottom-up” and “evolutionary”, which the government has disingenuously tried to apply to its plans.
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Readers' comments (3)
Patrick Newman | 3-Nov-2011 3:54 pm
Wishful thinking! There is no shortage of ideas and occasional examples but it is difficult to see what in the reforms are engines of innovation and integration. Indeed the consolidation of the internal market and the inexorable march of FT's to full independence create institutional barriers to progressive change. Perhaps I could mention Vanguard's Systems Thinking method as another approach to securing lasting improvements to care services.
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Anonymous | 4-Nov-2011 8:40 am
Bundled tariff?! Its a block contract!
Plus ca change.....
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Anonymous | 9-Nov-2011 12:31 pm
Not being unkind Alastair but this is an academic argument. Working in a PCT a real world view is that there is a lack of value based behaviour across the system. And because the coalition has chosen to focus, hypocritically given its stance in opposition, on structural change, there will not be much scope for clinicians in an economic downturn to behave other than defensively as they learn the ropes (and a lot may not want to even take them up). GPs in particular do not have a great reputation for their values; they are small business people employing practice managers whose primary focus is on income not strategy. FTs will be similarly driven by the need to cope with economic restrictions and boards will look inwards not outwards. It is very difficult to see where the kind of innovation you are proposing will come from other than nationally driven reconfiguration, nationally proscribed models of care, nationally driven incentives, and nationally driven models for shared services - all of which negates the purpose of setting up CCGs as locally sensitive commissioners. To rephrase an old strapline: The future is blight - the future is worrying.
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