Engaging ways to enhance healthcare

Author: Alex Thomson, Localis, in the MJ   |  

The Kent Health Commission has been set up to demonstrate how latest health reforms can be made to work for the benefit of all. Alex Thomson explains

With substantial changes set to take effect through the Health and Social Care Bill, there has been much discussion about what the healthcare landscape may look like in coming years.

A long-recognised but, until recently, somewhat taboo subject was the UK’s ageing population timebomb. By 2031, it is forecast, one in five people will be over the age of 65. This will bring particular challenges to care sectors.

In the present climate of fiscal austerity, budgets are already under more pressure than they have been for years. Yet, at the same time, the Open public services White Paper’s commitment to diversifying the nature of public service provision, together with decentralisation minister Greg Clark’s right of initiative, offer just some of the avenues for potential innovation.

Policy-makers and healthcare practioners are, therefore, currently grappling with a complex set of challenges and opportunities.

In light of this, Kent CC, together with Dover DC; Dover MP, Charlie Elphicke; local GPs; leading independent think-tank, Localis; and communications consultancy, MHP, have launched the Kent Health Commission.

Designed to demonstrate how the proposed reforms can deliver better quality care for patients, greater power for local GPs and other commissioners of care, as well as enhanced value for money for the taxpayer ? the commission is looking to push existing theory into meaningful practice for communities across the nation.

Building on broad political consensus in favour of early intervention, a key component of the Kent initiative involves modelling a partial shift in budgets from acute to community health, with the savings to be reinvested in service provision.

GPs will have an important role ? identifying how freed-up resources can be best used to deliver better community health across the board, and thereby, reduce the need for hospital admissions ? with all the stress to patients, extra workload for hospital employees, and general expense that brings. It is something for which local government has been calling for a very long time.

In order to empower local health professionals, and place power in the hands of those who know both the needs of their locality and the ins and outs of the system best,the commission will bring together GPs, clinical commissioning group representatives, local MPs and leading councillors ? both county and district, and emerging healthcare providers in charitable and voluntary sectors.

This will have the welcome effect of increasing participants’ awareness of the various strengths held by each stakeholder, and help produce a more joined-up system which prioritises patient outcomes over and above the source of delivery.

Tellingly, in late 2007, an Audit Commission review found that only 3.4% of combined health and social care budgets were spent on jointly commissioned services ? and, given the many overlaps between the two, particularly regarding care for the elderly, more could be done here.

All this is something of a step change, and requires careful management. Yet, importantly, the Kent model is built on engagement with local communities, rather than imposition from on high.

Existing resources would be shifted to where they can best help meet the diverse needs of residents, and this will involve refocusing priorities on preventing the need for hospital treatment in the first place. Consultation with residents and GPs will remain key, yet there are emerging signs that a shift from primary to community care can lead to positive outcomes. Early discussions with key stakeholders have proved fruitful.

The aim is to develop a visionary model which can best deliver the type of quality care, better health outcomes and improved patient districts. To do so, this project leans heavily on the experience of an initial pilot of the commissioning experience of Dover GPs.

By reporting the results of the Dover pilot to local and national stakeholders, all this will show how small shifts in budgets can produce far-reaching results for healthcare user and practitioner alike.

There are challenges ahead. The precise levers in health, care and local government systems which may best improve outcomes will inevitably necessitate a degree of trial and error ? but by building on the experiences of residents and GPs to date, there is scope to produce a much more intuitive system.

Out of the 101,000 pensioner households in East Kent, for example, almost half (46%) currently live alone. The most common mental illness among this age bracket is depression. Given that such people find it hard to reach out to get the help they need, there is much to be gained by recalibrating the healthcare system towards a more pro-active, community-based structure.

Integrating two huge areas ? with equally-entrenched super-structures ? such as health and social care, will be no mean feat, even given the desire among key participants to do so. Yet the potential gains make such an undertaking worth exploring.

For the pensioner whose current experience of the healthcare system may only be when they experience some form of accident, the work undertaken in this project will recast their overall experience ? potentially to address the above, more ‘social’ concerns, such as those surrounding mental health.

If the system proves incapable of adaptation, the years ahead may be painful, indeed.

But, if all participants show flexibility, integration between health, public health and social care services may not only ease the burden of budget cuts, but deliver a truly-accountable system with local people taking decisions that best suit their areas.

By taking on board the views of politicians, doctors and residents ? and integrating public, private and third sectors ? the new exemplar health system may look rather different from today’s model, but will be the better for it.

If you would like to be involved, e-mail chief.executive@localis.org.uk.

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