'After destructive debate, the case for reform needs to be rebuilt'

I can’t wait to get the Health Bill behind us. It has been frustrating to be stuck between a reorganisation I could not defend and an often destructive debate which treated any change with suspicion. There seems no doubt that the political capital for reform has been used up before the hard decisions have been made and an opportunity to have a realistic dialogue with the public has been missed.

HSJ argued that one of the key legacies of the Health and Social Care Bill will be the shadow it casts on the prospects for reform. Over the last year, many of the ingredients of reform have become perceived as threats rather than opportunities. A debate that has been framed in terms of competition, privatisation and marketisation now needs to be recast. And the government needs to find a way to rebuild trust and lead the change it wants to see.

As we take stock, the welcome focus on integration is part of that new narrative. But instead of being the competitive force described by Sir Stephen Bubb, most patient groups would rather get a hearing for the added value we can bring to the service.

That’s not about competition but about collaboration.

Transforming care for long term conditions, which make up two thirds of NHS costs, is vital to delivering the productivity challenge we need to meet. That means stepping up self-service care for those who can use it and targeting face-to-face support to those who need it most.

The Facebook generation is already online, helping themselves and each other to get on top of their asthma. In that environment, companies like Microsoft can help people share information but maintain the privacy of their data. Patient groups can provide tools, facilitation and content to make the experience effective. As a commuter, that works better for me than having to see a GP every time I need to manage symptoms, so long as people get educated about their condition at the point of diagnosis.

Patient groups can collaborate in traditional settings, too. Many repeat hospital admissions for asthma involve people with severe disease for whom there are no drug treatments. By creating peer support for them, Asthma UK can help reduce the number of admissions and average length of stay, an approach which is entirely complementary to clinical care.

Severe asthma can undermine relationships and make it harder to hold down a job or thrive at school. Up to 50 per cent of people with severe asthma in hospital settings have clinical depression. The same principles hold true for many long term conditions.

And because people with long term conditions are so central to productivity programmes, segmentation, targeting and risk management are critical. The NHS cannot tackle the causes that lead people back to hospital in single episodes of care. That’s why the manifesto for quality, innovation, productivity and prevention produced by 10 health charities last year, together with the King’s Fund, identified emotional and psychological support as a main theme.

We do need more diversity of provision, but not because another sector is better than the NHS. We need it because we need a different approach to managing chronic ill-health and we need it fast.

Patient groups should play a bigger part to influence patient behaviour. The private sector should play a bigger role if it can help us to better segment, target and manage risk populations.

No one is in any doubt that the NHS will remain the bedrock of care and other sectors will only thrive if they add value. Commissioners are comfortable about a managed market and able to get results from different providers.

Patient groups and private providers need to show what we can bring to the table, in terms of improved outcomes and health economics. But change will be in collaboration, not competition, with the NHS. For it to work, however, politicians need to talk about real choices and support hard decisions.

We all know that failing to make those decisions will in time deny care to those who need it most. Politics with a small ‘p’ has let down the case for reform. It now needs to be built back up, block by block.