Andrew Jones on long-term vision
Action is needed now if the major transformations of the health landscape are to be completed in the next half decade.
The health policy debate has generated much in the way of commentary and critique, but the reality is that we must reform healthcare for the benefit of everyone in the system.
Clearly managers deserve much credit for assisting the transition and indeed quantifying the scale of the challenge well in advance. They will now be required to deliver on some challenging efficiencies at a time of considerable upheaval.
Most of the debate so far has concentrated on the near term issues and clarifying missing details. The conversations that have not been had are the descriptions of what healthcare will look like in five years and more importantly what patients and carers will see and experience in this new world of asset-light products and services.
Having defended some of the challenges it is fair to say that policy progress would benefit from a clearer description of the vision. We need to build some excitement in the potential for primary and public health to promote ambulatory care and to enter the blue oceans of personalisation and prevention.
We also need to ensure GPs buy in to and develop competency to deal with the main health trends of an ageing population with more chronic disease, which were locked in to place many years ago. If you think this is tough, think about 2014-15 if we haven’t moved far and fast enough. So how should we describe the success criteria by which health policy is judged?
First, in an outcome based framework, success must clearly be judged on outcome measures. Policy implementation alone won’t cut it - the trajectory of mortality amenable to care in comparison with our economic peers must start to change lanes.
Cancer and cardiovascular survival rates are obvious picks and should be central to GPs and commissioning board balanced scorecards. Coupled with this must also follow the narrowing of health inequality - infant mortality and life expectancy are the kind of things which will really matter. What gets measured after all will get managed.
Second, this is not going to land well unless healthcare in the public system is considered from the eyes of the consumer. Public and professionals are going to become equal partners not because of a Whitehall directive but because of access to knowledge.
The public will need to see local services that deliver a different care experience that is both accessible and joined up. Every other consumer industry depends on buyer utility guiding demand and with a business led economic recovery the gap in traditional hospital services is going to look bigger. We almost need to get to the point where local populations are calling for the new models of care rather than campaigning against the removal of a building.
It is worth remembering that many industries have given power to their customers at the same time as reducing costs, so-called co-creation.
Third, by the next election the personalised health information revolution will need to be well established. Patients want to know more about their care, they want to book and access services online and they want to know whether those providing the care are expert in their condition. They also want information about relevant local services and these can be supplied much as other consumer organisations segment marketing approaches. This can only occur with liberalisation of data sets and care records with the appropriate permissions.
Perception of value, or in this case choice and quality, decides which businesses thrive, or fail, and must surely happen in healthcare too. The informed customer stopped shopping at Woolworths - similarly, the informed consumer might choose to drive past certain care providers.
Fourth, we should expect to see new solutions and markets for wellbeing. As the public health white paper signals health assessments for disease risk factors, behavioural change programmes and chronic disease management will become bigger in communities, schools and the workplace than in healthcare.
But a true provider market for public health will need compelling incentives, like national insurance on both the employer and employee side to motivate those who embrace change with proven impacts.
Finally, health policy will move from the edge to the centre of politics. Conservative governments are returned for home security and economic confidence - they do not win if the electorate loses confidence in public services. Health policy is now high enough on the radar that it will become one of the key barometers by which the coalition government will be judged in 2015.
Western populations want to spend higher proportions of GDP on healthcare but only if they can see and feel the benefits. Existing challenges, the reorganisation of the system and a natural commissioning cycle of about three years mean that we are getting close to the critical velocity, the speed at which take-off is unavoidable and the opportunity to consider alternatives diminishes. Health select committee reports and Cabinet Office commentaries have suddenly become compelling reading.
- Acute care
- Clinical Leaders
- Comprehensive spending review 2010
- Government/DH policy
- GP commissioning/practice based commissioning (PBC)
- Health inequalities
- Health white paper
- Lib Dem-Tory coalition
- Long term conditions
- Patient experience
- Public and patient involvement
- Public health