My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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What’s wrong with modern health systems – an analogy. Plus an explanation of what I mean by the cost and price of failure in the NHS and the Canadian health system.

Filed Under (Canada, Health Improvement, Resources) by Paul on 15-11-2012

Whilst in Canada I spoke at a conference run by the Ontario Hospital Association (the equivalent of our Confederation but only covering hospitals). The opening speaker was Don Berwick who, whilst being from the US is no stranger to the NHS and its reform. Don helped to set up one of the best health improvement organisations in the world – the Institute of Health Improvement (the IHI, the website is well worth a visit) and it was as the IHI that he spent much of the late 90s and the first decade of this century helping the NHS.

Don has had a tough couple of years because he was asked by President Obama to run Medicaid and Medicare (budget of over £900 billion) who provide the health care for retired and some poorer US citizens. This is the world’s most important job in socialised medicine, but given the vicious and riven nature of US politics at the moment, the whole might of the Republican political machine has been pressed into service to destabilise the office holder.

President Obama’s new health reforms needed strong Medicaid and Medicare leadership so it was in the interests of opposition politics to destabilise that post.

Don has left that post now and he gave, as always, an interesting analysis of how to improve socialised medicine whilst cutting costs. His talk started with an analogy explaining the problem for modern health care systems that I found to be one of the best I have heard.

He started with a photo of a big strong bridge. The Cholutea Bridge. This was built by the Japanese in Honduras in 1994. It was built to withstand very bad hurricanes so it was built with great strength and strong foundations.

This was just as well because in the year after completion there was a hurricane which smashed over 150 bridges across Central America. But not the Cholutea Bridge. Once the wind stopped the bridge could be seen to have done its job. It had held.  It was still there – a clear victory for modern engineering.

The problem was that the hurricane had moved the river.

And of course Don’s point is that this is the problem for modern health care. We have built a strong health care system, but the sorts of health care we need have moved. The development of episodic health care has been very good, but the river we now need to bridge is long term conditions. To continue the analogy if the purpose of the health care system is to cross the river of health care need then we need to move the bridge to deal with a new health care problem.

And that is a big deal – and gauges the size of the problem.

Some people commented about the way in which I styled the problem about long term care in Monday’s post. I was claiming that a lot of the expenditure on long term care that ended up in emergency beds in hospital was caused by failure of other aspects of health care.

This seems a harsh judgement and may be worth explaining.

The clearest way of explaining this is by looking at the report of the Public Accounts Select Committee from last week. The 17th report of the PAC in the 2012/3 session of the House of Commons was on the management of adult diabetes services in the NHS.

It begins with a fact about failure that is not a resource expense but a human one.

“24,000 people die prematurely every year because their diabetes has not been managed effectively”

This is one kind of price of failure. What the PAC is saying is that if these people’s diabetes had been managed effectively they would not have died. It’s a big claim but it is echoed by the same figure reported in April by UK Diabetes the State of the Nation report.

But the PAC – being a committee interested in economics goes on to talk about money,

“The NHS spends at least £3.9 billion a year on diabetes services and around 80% of that goes on treating avoidable complications”

Their point is that different health care would avoid these complications, so the price of the failure of avoidable complications is about £3.1 billion.

Interestingly the publication of these figures did not get much more than a murmur of publicity. We have become inured to them and seem to expect nothing better.

My point from Monday’s post is that along with Ontario (and the NHS) we can ignore this cost of failure only when we have the money to pay for the outcomes of failure. But in Ontario, and in England, we are coming to the end of the times when we can afford to spend 8 out of every 10 pounds of NHS money on failure.


One Response to “What’s wrong with modern health systems – an analogy. Plus an explanation of what I mean by the cost and price of failure in the NHS and the Canadian health system.”

  1. Radical change is needed in the NHS if it is to survive.

    Your comments about management of diabetes and the figures surrounding it are interesting. Where does patient responsibility fit into this? How many of those deaths were from medical error and how many from poor compliance and poor lifestyle?

    I think one of the biggest needs is for people to accept responsibility for their health. So many want a pill to cure every ill without any effort on their part. They see it as the doctors responsibility to fix all their health problems.

    Healthcare should be a partnership between clinician and patient as both have a role to play.

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