Procedures for healthcare devolution
Author: Alex Thomson, Localis |
Writing for the MJ, Alex Thomson writes on healthcare devolution.
As is often remarked, the NHS has long been something of a national religion ? not just an organisation that we can rely on in times of need, but something in which we collectively have invested our faith and trust.
The ‘N’ in NHS has come to be a key part of this: a feeling that we are all in the same boat, buoyed by relying on the same unimaginably large and complex organisation wherever we are in the country.
So it is unsurprising that we have come to expect consistent excellent standards across the country and anything that diverges from this national mean is not acceptable.
That is why scandals such as Mid Staffs are so shocking ? not just the horrific failures of care, but the sullying of an iconic national institution.
This warm reverence towards the NHS is particularly true for many on the left who see it as one of, if not the, proudest achievement of Labour’s time in office.
As a result, any radical shift away from the traditional template the NHS was put together on in 1948 is often reacted to with suspicion and even blind opposition by some of those in the red corner.
This goes some way to explaining the differences which arose in February of this year between then shadow health secretary Andy Burnham and Labour local government leaders when the devolution of all local health and social care budgets to Greater Manchester was first announced.
Instead of welcoming this remarkable and historic power gain for what is not just very much a Labour city but the city in which he has been an MP for nearly 15 years, Mr Burnham opposed the devolution announcement on the grounds that it diverged from the idea of national standards, comparing it to a Swiss cheese.
In doing so, he put himself at odds with his party’s local leaders in Greater Manchester and then later with the then shadow chancellor Ed Balls, all of whom welcomed the announcement.
The whole episode was not only an interesting reflection on Labour Party politics at the time ? Sir Richard Leese’s alleged response to his then leader’s request to rubbish the chancellor’s speech was sufficiently robust to be unquotable in a family magazine such as The MJ ? but also the general shift in opinion across the political spectrum that the future of the health service is increasingly local and there is need for reform.
So what has changed to advocate moving away from the deeply embedded ‘command and control’ approach to healthcare provision?
In short, because the current system just isn’t working as well as it needs to in order to have a sustainable future and the recognition that a more locally attuned approach could deliver big benefits.
The advantages that more locally-focused delivery can bring are well described in an essay by Stephen Dorrell in a Localis publication earlier this year, in which he explains how more local management brings more efficiency and accountability to health services.
This latter point contrasts with the current situation where the NHS can often seem to patients to be something of an amorphous blob where visible oversight is all but absent.
The coalition Government started the ball rolling, introducing policies such as the Better Care Fund as well as negotiating the aforementioned Greater Manchester devolution deal with Labour local government leaders.
The new Government continues to support this analysis.
Jeremy Hunt’s speech in July on changing the culture in the NHS to be more human-centred is a case in point.
There is also a notable shift in the media.
Centre-left columnists such as Polly Toynbee and Jenni Russell have recently written pieces accepting the need for large-scale reform within the health sector.
The latter highlighted several gulfs that exist within the NHS ? in standards across the country, between the standard of service we expect and that which we receive and in understanding in a culture which often fails to meet patient’s needs ? and notes the need for innovation.
Perhaps most importantly of all, many people within the health sector accept this need for reform as well.
As articulated in NHS England’s Five Year Forward View, the organisation will be testing different models of care delivery in different areas of the country to determine which work best.
In 37 vanguard sites, local health partners are redesigning care models to be more attuned to their patients and deliver better outcomes in a more sustainable fashion.
Although this represents something of a divergence from what is seen as one of the founding principle of the NHS, there is recognition that it is perhaps the only way we can maintain the most cardinal of those principles ? delivering good quality care across the country, free at the point of use, to those in need.
So, if the future of health delivery is indeed local, what does this mean?
This question is the key focus of an exciting research project that we are just starting in association with KPMG, looking at the next generation of local care models and how they are implemented.
The project will have a particular focus on those cohorts that tend not to get much attention such as patients with learning disabilities, mental health issues and individuals with complex dependencies.
That said, our research will of course not ignore other cohorts such as older people ? given their impact on the demand side of the healthcare equation, to do so would be perverse.
There are undoubtedly challenges that lie ahead. In the project we will consider not just the greater opportunities for innovation, but also the risk elements that increased health devolution will bring.
How will local leadership, for example, adjust to this new landscape of risk?
Are leaders really ready to take the flak for closing hospitals?
And how will they adjust to working with other areas of the public sector where relationships are fledgling at best?
A recent case in Greater Manchester exemplifies the challenges of the latter question.
The Pennine Acute NHS Trust has planned to move in-patient surgery and day and trauma surgery from one Greater Manchester hospital to another in the past few years.
This was news to local political leaders when leaked and highlights the difficulties even in communication in the evolving local healthcare framework.
There are also significant challenges related to actual implementation.
Do local areas have the capacity to manage and deliver better healthcare?
How long do places need to prepare for such monumental change?
How will local leaders overcome the huge cultural schisms within and between local public sector partners integrated into the new healthcare framework?
With much thought and discussion around the devolution agenda concerning economic development, skills and infrastructure, these policy areas seem to be the stock tenets for most devolution deals.
Many places waiting to see the results in Greater Manchester before committing to healthcare devolution, these are all hugely important questions for everyone across the local government and health sectors.
The scale of the challenge ahead suggests that answers will have to come from a cross-party approach.
The Greater Manchester example, where, as already discussed, Labour local leaders negotiated with a Conservative chancellor, is a positive start.
It is therefore fantastic that we have Tony Lloyd ? the interim mayor of Greater Manchester ? speaking at our Conservative Party Conference event on devolved healthcare.
We hope MJ readers will be able to join us there and look forward to speaking to you then.
Click here to read the full article.
Localis are working with KPMG on a major piece of thought leadership looking at the next generation of care models. Read more about it here.