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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How commissioners can develop new value with the NHS

Filed Under (GP Commissioning, Patient involvement, Reform of the NHS, Self Management) by Paul on 30-10-2012

This morning I will be on the platform at the beginning of the National Association of Primary Care’s (NAPC) conference talking to one of the two GP organisations that have helped develop GP led commissioning. I am one of four speakers speaking on the theme of “Transforming the NHS”. Unfortunately for the NHS, transformation is a topic that has been much discussed but rarely put into practice.

And  transformation is indeed what the NHS needs if it is going to survive the imbalance between the flat level of resources over the rest of this decade and a rising annual demand for health care of between 3 and 4% a year.

The example of transformation about which I am talking (and have posted on before in this blog) concerns the increase in value that could come from much greater involvement of patients as ‘assets’ working with their long term conditions.

Health care in developed countries currently obtains its value from a trio of sources – health professionals, their kits, and drugs. Within this paradigm what we have learnt is that if there is a growing demand for health care (as there is at the moment) then the amount of one, or all three, of these sources of value needs to be increased. The historical problem at the moment is that there is no extra resource with which to buy the extra components itemised above.

Most people in health care don’t really believe this. In the US, in France and in the UK there is a belief amongst medical staff, technology firms and pharma companies that the money will be found from somewhere. It’s as if they don’t read the financial bits of the newspapers which predict flat growth, but instead read the astrology charts to find one that promises that something will turn up with extra money.

(I was at a Royal College the other day and the chair put it very well when he said that some in the NHS seem to have the expectation that very large diamond mines will soon be found in the Chilterns. His point was that it will take ‘magic’ thinking like this to find the extra money for the NHS to get out of making the very difficult decisions that are coming up).

There will be no more money to buy extra staff kit or drugs. The money we have is the money we will have. No more.

The slides I am using for my talk are available here. They go beyond making the general argument for improved self management to report on some of the work that has been taking place in six different localities in the NHS.

As you can see there has been some supplementary funding and resource to help these localities from the National Endowment for Science Technology and the Arts (NESTA). They, together with the Innovation Unit, have helped to develop these examples.

The point of them is twofold.

First if we invest in patients as assets they will create value rather than simply acting as sponges mopping up value provided by others. This means that they could add considerably to the capacity of the NHS to meet extra demand.

Second the only way in which this can be scaled up to become big enough to help save the NHS is by making very radical changes to the ways in which patient pathways are developed.

My point to the NAPC is that unless GP commissioners change what they are commissioning this extra value will not be created. Investing in patients – when compared to investing in emergency beds – is a much cheaper way of creating value.

However what commissioners need to know is that investment in patients is not free. It needs to be paid for just like every other value creator. But this value will cost commissioners a great less than all others.

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  1. […] spoke about this at the NAPC in October and will do so again at the Alliance. What is important for today’s audience is to […]

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