Transforming health and social care delivery in the UK
For the first time in its history the NHS will see its budget frozen over at least the next four years, an issue exacerbated by government targets for £20 billion of 'efficiency savings' by 2015. Some NHS organisations at a local level have large and growing deficits that seem likely to increase. But despite this unprecedented financial burden the system, at an aggregate level, is coping and patient care hasn't been affected. Yet.
It was against this backdrop that Professor Chris Ham, Chief Executive of the influential healthcare think tank The King's Fund, delivered the first School of Health Sciences Dean's lecture of the academic year. Professor Ham identified four key issues affecting the NHS which he called his 'burning platforms'; 'Funding problems, the Health and Social Care Act, the Francis Report into the deaths at the Mid-Staffordshire hospital and finally the distinction between services and structures.
One of the biggest changes to affecting healthcare in the UK for a long time has been the introduction of the 'Health and Social Care Act 2012' which, according to Professor Ham, will mean "Massive organisational change, loss of experienced managers, increased complexity and a focus on structures and not services."
It was no surprise to the audience, comprised of academics, health and social care practitioners and School of Health Sciences students, to hear that the Francis Report into the tragic deaths at Mid-Staffordshire hospital, which is now due for publication on January 2013, will be a significant moment for the NHS. Especially if, as is widely expected, the report will highlight systemic failures at all levels.
The fourth of Professor Ham's 'burning platforms' and in his opinion the most important is the need to drive toward a service orientated NHS and presented his case for a change (see side bar): "The performance of the NHS has improved greatly but the current model of health and care delivery is outmoded." Which the structure focused orientated approach of the Health and Social Care Act surely seems diametrically opposed.
The Kings Fund's model for a better health and social care system is one that enhances the role of patients and users in the care team, rethinks the location of care, embraces new technologies and makes better use of data and information.
However, Professor Ham stressed that the institutional inertia of the NHS will be a significant stumbling block to change and that without recognition and empowerment of clinical and managerial leaders from government lasting and effective reform of the NHS is unlikely to be successful.