Prescribing change for the NHS is easy but it is extremely hard to implement, says Edmund Stubbs
Healthcare stakeholders are in agreement as never before on the desirability of moving care from hospital into the community, focusing far more on prevention and good disease management. However, with such widespread agreement, is it not surprising so little action has been taken to implement any large scale changes?
The reason for this administrative foot dragging has much to do with what, as a nation, we consider “good healthcare” to be. Ask just about anyone what they want from the NHS and they will answer in terms of state of the art hi-tech hospitals, the latest drugs, complex procedures and the highest numbers of doctors and nurses possible.
While these remain admirable and necessary resources for an acute hospital, if we are to save the NHS from financial meltdown it is imperative that we combat the belief that these factors are what truly represent “good healthcare”.
‘Many of the fixed, preconceived, ideas regarding healthcare must be challenged at the public level’
Instead, the public needs to be encouraged to think of a competent NHS as being there to predict, prevent and control illness, working with the individual to preserve their personal health.
In a sense, as soon as possible, a stay in hospital ought to be seen by society as a failure of our national preventative healthcare system; a system that must be working in combination with efforts to combat social and economic causes of poor health.
In an ideal future, you and I should take pride in belonging to a generally healthy population served by only a few excellent acute care hospitals. This future ideal is in stark contrast with the present public mindset, where success is too often measured in terms of how many hospital nurses are employed or how many acute hospital beds are available.
Sadly, such statistics often represent the only means of assessing the quality of a national healthcare system, often also forming the basis of international comparisons.
Health stakeholders in developed economies are now recognising the futility of concentrating solely on the escalation of acute intervention services. Most specialists acknowledge that in fact the demand for acute intervention must be reduced. However, for such change to occur on a large scale two conditions will be necessary:
‘Managers must be granted real power to shift the emphasis of healthcare away from hospital to the community’
Managers must be granted real power to shift the emphasis of healthcare away from hospital care to the community; and this authority can only be given to them by politicians willing to implement necessary policies; policies that currently fly in the face of public opinion.
It will be impossible for politicians to take action unless public opinion changes first. The average UK citizen should no longer conjure up images of flashing blue lights and million pound scanners when they think of modern medicine.
Instead they should be encouraged to focus on the attention to detail and professional manner of the community care team who successfully managed their grandmother’s increasing frailty, allowing her to remain in her own home for as long as possible; or the support and guidance given to an obese father leading him to lose weight and reduce his cholesterol level by modifying his diet and increasing his exercise.
Until society adopts a community centred, low key idea, of “good healthcare”, a challenge to the expensive interventionist status quo is likely to be fiercely opposed.
Any attempt to shift care and its funding into the community at the expense of say a local hospital, or a ward closure would look like cost cutting and be regarded with the utmost suspicion. Hence the need for a changed public opinion to encourage the part of politicians and managers.
In short, many of the fixed, preconceived ideas regarding healthcare must be challenged at the public level. The assumption cannot remain that our population must inevitably remain as unhealthy as it is now.
With increased preventative medicine and social care the time could come when only a few short hospital interventions throughout life might be necessary; the exception rather than the rule – especially in relation to end of life care, enabling people to end their days with dignity in their own homes rather than at the end of a lengthy and costly stay in an impersonal hospital environment.
‘The time could come when only a few short hospital interventions throughout life might be necessary’
Such a shift from crisis intervention to integrated social healthcare represents the “hope for the future” that many stakeholders say the NHS needs. One where staff keep a local population healthy and happy for as long as possible, rather than struggling with sparse resources to save desperately ill people.
A ring at the doorbell from the district nurse, or Skype consultations in care homes may not generate the excitement needed to feature on an episode of Holby City, but they are probably much more effective.
Edmund Stubbs is a healthcare research fellow for CIVITAS, the Institute for the Study of Civil Society