An architect of Labour’s NHS reforms explains why he has decided to take a role as health adviser to the Conservatives
Sequencing the human genome ushered in an age of “personalised medicine” in which it was hypothesised that treatment would be tailored to the patient’s genetic make-up. Selection of specific drugs, doses and schedules would be predicated on genotype, increasing safety, reducing costs and improving clinical outcome. A steadily growing number of such biomarkers are being successfully applied to cancer therapy.
I deeply regret the latest round of NHS reforms dampening down patient and public representation
Can we build on this concept and personalise health policy?
If we look back at Labour’s influence on health policy over the past 13 years, we must acknowledge some improvements; after all, health expenditure doubled. Blairite reforms of public services were based on choice and competition, and the foundation trust initiative set elements of the NHS free to innovate and enhance contestability.
But central constraints, driven by process oriented targets, seemed to stop the reforms in their tracks, and we have reverted to governance by central diktat, as one-size-fits-all targets move us further away from the health outcomes that really make a difference.
In contrast we have an opposition party with a broad health policy theme which is focused on autonomy and accountability rather than top-down control, and will scrap centrally imposed process driven targets and replace them with a new focus on outcomes.
If we take cancer as an example, rather than overwhelm multidisciplinary teams with the 2,000 or so measures so far collected by the cancer action teams, the focus should be on clinical outcome data (eg, one year recurrence rates, five year survival rates, chemotherapy-associated mortality) to be provided annually, benchmarked to a national average, allowing comparisons between cancer treatment centres both in the UK and internationally.
Professional pride would mandate that underperforming teams would act to improve the quality of their service, and that this could be further incentivised through payment by results. Making this data available in a digestible and easily understandable format to citizens will empower a truer sense of their choice and enable competition.
Why choice failed
Choice failed before because it was predicated on access and dependent on the willingness of patients to travel for relatively minor procedures. This did not catch the public’s imagination and was bureaucratic. But if we show there are marked differences in the potential to be cured from cancer, then we know this will serve as a real spur for patients to seek optimal treatment.
We ran a series of large town hall events in Scotland when I chaired the review of Scotland’s NHS, and we were told plainly that citizens would travel for treatment if we provided the evidence of benefit; otherwise, we were told, keep the NHS as local as possible.
The other areas of Conservative policy which will drive the NHS to take a more personalised approach to delivery of healthcare include proposals to help patients select their GP practice, improve out of hours cover, establish commissioning guidelines encompassing entitlements to care and offer personal budgets to those with stable, predictable, long term conditions.
It is also now evident that the Conservative party leadership is completely committed to the founding tenets of the NHS, free at the point of delivery and universally accessible.
One of the deepest regrets I have over the latest round of NHS reforms is the dampening down of patient and public representation. We lost community health councils, we mislaid patient forums and fail to understand “local involvement networks”. Shadow health secretary Andrew Lansley has a simpler, more effective means of amplifying the patient’s voice and making the NHS accountable. He will establish “Health Watch” to provide support to patients at a national level and leadership to patient representative bodies at a local level.
Health Watch will incorporate the functions of the Independent Complaints Advisory Board, with statutory rights to be consulted on guidelines issued nationally concerning the care NHS patients should receive (ie, commissioning guidelines). It will also be able to make representations to the NHS board in relation to the planning of NHS services, such as where an accident and emergency department closure is proposed.
So, we have a Conservative party which has made the NHS its priority and which will introduce a raft of galvanising measures to redirect the focus of the NHS from process drawn targets to clinical outcomes. Patients will benefit, and not before time.