No quick fix
Author: Steven Howell, in the MJ |
Steven Howell reports on a round table debate with Pfizer Ltd, that forms part of a wider research project looking at the new health and public health landscape.
Fans of the BBC’s Casualty might be used to the frenetic action of an A&E ward, featuring the expected array of doctors, nurses and paramedics and associated melodrama, but perhaps soon we’ll see the recurring characters of Dr Jones, the local GP lead, or ‘Councillor Friendly’, the helpful health and wellbeing board chair, discussing the merits of a payment by results system over coffee at the nurse’s station. Or perhaps not.
Regardless of its primetime television appeal, or lack thereof, the transfer of a significant chunk of public health back to local government alongside gaining strategic oversight of the wider healthcare agenda (through health and wellbeing boards) represents perhaps the biggest opportunity for local government in a generation.
But for all the talk about change and transition, what will actually change in practice? That’s precisely what we asked senior local government figures, MPs and experts at our latest round table discussion.
Naturally, the biggest theme was finance and, related to that, integration. The question of how to solve a budget problem like demographic change is being addressed by national figures from across the political spectrum. With the coalition government launching integration pilots that build on the work already underway both nationally and locally; and Labour establishing an Integration Commission to report in a year’s time, the profile of the issue has risen dramatically in recent months.
In fact, local government has long been an advocate of a more joined up approach, particularly with regard to health and social care. One participant affirmed the consensus that it is no longer possible to exist in separate silos owing to the financial pressures and demographic changes, while another described structural changes as ‘inevitable’.
In their view, both sides realise that this culture shift needs to happen. Joint budgets, which exist in some form in parts of the country, could well be the way forward in the view of the participants.
There was also, linked to the integration theme, the notion of transferring investment from acute provision to preventative interventions. Councils such as Cheshire West and Chester, Essex, Kent and many others have pushed hard to make the case for this shift in mentality towards preventative services.
Indeed, the comments made by Duncan Selbie, chief executive of Public Health England, have been deeply encouraging. However, participants to the debate felt that in order to stop individuals ‘escalating up the health ladder’ plenty of hard work and discussions will be required over the coming months and, perhaps, years. Another major theme of the debate revolved around what local government could bring to the table in terms of value for money.
It is clear both from the debate and from our emerging research that local government thinks it can offer considerable expertise in this area; particularly in facilitating the joining up of service delivery and working via health and wellbeing boards to encourage outcome-focused service delivery.
Those in local government that have a little more knowledge of how the NHS works will not be surprised to hear that the National Tariff was raised. Indeed, one participant suggested that the current tariff payment system to hospitals is providing perverse incentives to maintain the status quo.
Central agencies have recognised such calls, with Monitor and NHS England committing to a review of the payment system. They acknowledge feedback from the health sector which suggested that ‘the current system is not sufficiently patient focused, not always based on good quality information, and can act as a barrier to delivering integrated care.’
Any changes would, of course, take time to implement – the Monitor/NHS England review is looking at possibilities for 2015/16 onwards – but local government (and undoubtedly GP colleagues) of course doesn’t want to sit idle until then, and no doubt will be making the case for local arrangements that incentivise new ways of working.
Ultimately, the general diagnosis was one of healthy prospects. Change will take time, but the participants were positive about what local government had to offer and how it could work with clinical and frontline colleagues to develop an enhanced and integrated healthcare system.
While I’m sure Charlie Fairhead might have some sensible and level-headed thoughts on successfully developing a better healthcare system, in the absence of his scriptwriters I’ll leave you with the view of one participant: ‘Whatever the governance arrangements are, it will depend on like-minded people coming together and encouraging revolution.’
Some might argue that encouraging quiet revolutions is just what local government is known for.