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.