Another 600 mile round trip sitting in traffic leaves plenty of time to think.
The Health Select Committee has said that the NHS isn’t ‘awash with cash’ and argues that last year’s Autumn Statement provided an NHS settlement of an extra £4.5bn, not the £10bn that has been reported by Government. The £10bn is calculated in real terms once inflation has been taken into account say Ministers. The Health Select Committee however says the Government has added extra years to the spending review period and relies on cuts elsewhere in the public health or social care sectors. The Select Committee argument seems to be predicated on ‘it’s not what Simon Stevens (Head of NHS England) asked for’; therefore more money should be allocated – really? I want more so I should have it? Is that how we allocate public funds?
Other commentators say we shouldn’t throw money at the NHS because the challenge lies in funding social care (Richard Murray – King’s Fund). Then the Health Foundation Think Tank says “immediate action to support social care is needed BUT without funding growth for the health service it’s hard to see how the range and quality of care for patients will be sustained”. The BMA joins in saying the funding crisis can’t be solved through further efficiency savings and in fact the NHS community and social care system is “on the brink of collapse”. Oh and the Government say local authority social care spending has up to £3.5bn of ‘new support’.
Confused? I am.
We have a multi-agency agreement to develop 44 local Sustainability and Transformation Plans (STP) across the health and social care system designed, as Simon Stevens said, “To confront, not duck, the big local choices needed to improve health and care across England over the next five years “. Each of the “footprints” is a collaboration between all the statutory bodies in the area involved in health and social care. You would think that this offers, again as Stevens puts it, the chance for “unprecedented” cooperation between organisations. That’s a good thing, right? In Lancashire and South Cumbria for example there are 31 different statutory bodies. There are also voluntary organisations, health watch branches and local GP forums.
It ought to work and yet because behind the STPs lies the need to find £22bn of savings, inevitably what starts out as “unprecedented cooperation” turns into argument, bed reductions and as Chris Ham of the King’s Fund says, “bruising rows about ill-conceived closures”. We’re told that this is because STP areas are bringing together agencies with different agendas, following often unpopular and challenging paths using bodies with no formal power across a wider footprint and no history of cooperation.
As a result of this cooperation we’ve seen to date many draft STPs “leaked”, seven alone by local authorities, ahead of NHS planned timetables. To what end? The Huffington Post reports that STPs are “a major threat to the continued existence of the NHS”. It will be “devastating” and plans are based on “wilful self-delusion”. Oh come on – shouldn’t we be bigger than this? Sensible contributors, for example at the NW London STP say “We all recognise that we don’t agree on everything, however this will not stop us working together to improve the health and wellbeing of our residents.” Why do others always find ways NOT to do things? We have such wonderful examples of care and service improvement, of individual commitment and willingness to learn how to be better – and yet we also have structural and collective failure, carelessness and poor attitudes or obstinacy. I know it’s got to be hard to deliver perfect care services 24/7. It isn’t always going to be right because mistakes happen. But our senior leaders are paid well to manage these challenging issues and work together to do so. I’m lost as to why we allow egos and competition, silo management and unnecessary central reporting and rules to get in the way of what our care services do best? This isn’t about money belonging to individual Chief Executives or Council leaders. It’s the tax payer’s money designed to get the best out of our care system and if you are paid to make the best decisions you can with the money you’ve got in the interest of those who use the service then get on and do it. Don’t participate in the process and then ‘leak’ the results and say the outcome isn’t what you wanted.
We know that the poorest, the most elderly and the most vulnerable in society need our statutory services most of all. And we should protect appropriate access to our services for all including focussing on those most in need. I know it can be hard and at a personal level I don’t want my mum travelling miles to find a service that is open three mornings a week somewhere between major towns and cities. Not everyone has a car. Not everyone lives near main roads. BUT crucially, also not everyone needs an A+E because we know that good quality primary, community and social care can prevent hospital admission. We know too that specialist care might be better provided in well-resourced services supported by appropriately trained high quality experienced staff. So for most care we can and should rethink how it is offered and learn from others in this country and elsewhere that have already trodden that path.
There is a danger that we might adopt a bunker mentality perhaps being too cautious and dismissing for example the impact that technology can make on home or self-caring; we might be ignoring how we can improve health and social care’s antiquated appointment and booking systems; perhaps we are putting to one side the huge savings that can still be made from rationalising and sharing estate, back office, infrastructure and clinical process improvements and in many cases we aren’t even challenging behaviours, employment terms and conditions and the required appropriate skill levels for individual user needs.
STPs aren’t a panacea but the shared approach philosophy should help us support out of hospital care, prevent admissions, challenge the solutions for outcome based pathways of care, review cost make up of services and question why we are looking inwardly at government led administrative reporting instead of outwards towards the patient experience. Reductions in hospital bed numbers and developments in neighbourhood working through integrated care programmes with improvements in the use of ICT should change our estates capabilities and requirements leading to costs savings. Seeing health and social care providers working together SHOULD deliver real changes as envisaged by Government.
And yet the arguments instead as described above means that we are failing those same vulnerable service users we say we are there to support. The NHS of today is not the NHS of 1948. Our proud and passionate protection of the NHS is vital but we surely shouldn’t be blind to its failings. Equally social care is able to be so much more efficient and focused on need than is currently the case.
Look at the recent headlines telling us that still only 4% of GP appointments are booked on-line. That 30% of acute and specialist trusts are engaged in merger talks or hospital chains. That cyber-attacks are threatening patient data and that continued reporting by the CQC of poor care means increasing number of services require improvements. Our world is changing and I genuinely have no idea how much money the NHS needs but as the Chair of the Health Select Committee (back to where we started) said, “we really need clarity and if there isn’t any more money then (we) should have an honest discussion”.
Time now for that honest discussion? Because like those traffic jam signs on motorways that say “you are the traffic” surely our failure to grasp the realities and implications of REAL change mean that we are causing the traffic jam.
