The parlous state of NHS finances and getting change done
The Kings Fund tell us we’re doomed etc
Nearly 20 years ago, Wanless told us if we didn’t inject more money into the NHS we were doomed. To their credit, the govt of the time did so, but also introduced many policy innovations that you can directly trace to today.
We’re now back where we were 20 yrs ago?
Of note, Wanless also told us that unless we sort out social care and public health we’d also be doomed. I don’t know the extent to which social care was sorted – experts in such matters may comment.
We pretty much ignored the public health recommendations tho, and continued to raid the PH budget to pay for hospital over spends
Plus ca change.
Back to now.
In the excellent KF block there is a powerful graph showing the rapid deterioration of finance situation
My quip (nb the word I’ve used) was that as its the whole of NHS that is increasingly in the red, this time round (unlike previous crises where there was some cash sloshing somewhere, and an SHA to broker it) it won’t be Monopoly money…. It will be real hard folding.
I suggested this was an opportunity to get big change done
Then was asked what change
It took me 7.2 minutes to come up with the list below. It’s only a start, but it’ll keep me busy for a while
1. kick pharma and device manufacturer influence out of policy making
Not just device manufacturers but also procedure. Eg variance in TAVI.
2. fundamental change pact btwn citizen and state and pt expectation
3. tune down specialism tune up (with mega steroid dose) generalist
But need to be careful re the generalist, specialist pendulum
Partha Kar suggests that being overly aggressive here has nose dived Type 1 diabetes care in this country and that NHS really bad at tempering its swing..so we need to learn how far to go
4. vertical and horizontal integration. Population focused care
This is accountable care in another guise
It’s not a panacea
I’ll write more on this later
5. abandon NHS commissioning as currently incepted
Tin hat on
6. shift from PRB to outcome modified capitation
7. Don’t over focus on one thing
Spread your bets
A single thing isn’t going to solve it.
8. Dont over focus on organisational form, org charts etc
Focus on CULTURE.
Doctor / patient
Citizen / NHS
GP / consultant
Generalist / specialist
Clinician / manager
9. Adopt an improvement methodology mindset.
Measure what matters
Act on your measurements
I could go on
And I know everyone else has their own ideas
some powerful vested interests in the way here.
Someone lend me a steamroller