High stakes with the Health and Social Care Bill last week. But at our Health Policy Summit 2012 we pushed aside for a minute big reform, structures, and long run consensus-dividers such as competition/choice, public/private, and command versus autonomy.
Instead, we majored on – as guest Don Berwick so thoughtfully put it – ‘contextually adaptive changes’.
A physician who was formerly chief of the Centers for Medicaid and Medicare and the Institute for Healthcare Improvement, Don was upbeat that with the right changes productivity levels could be doubled.
Some ingredients: use data to point out variations, ‘put the patient in the room’ when designing all levels of care to avoid a compassion desert, and use the power of government to accelerate progress.
For Dr Devi Shetty, dubbed by the Washington Post as the ‘Henry Ford’ cardiac surgeon in India, the route to high quality bypass surgery for low cost (currently $1200 in his centres) included a motivated workforce selected and trained locally, high volume 24/7 surgery and daily data, on activity and cost relative to income, texted to clinical personnel.
He aims to reduce costs to $800 to make cardiac surgery more affordable for those who need it. Add to this pizzazz his useable maxim from former patient Mother Teresa: 'Helping hands are better than praying lips' and the result was no less than inspiring.
What sort of ingredients would glue together networks of providers to do the right thing e.g. coordinate, take risk, deliver high quality, to time and on budget?
Iain McCormick from New Zealand explained how alliance contracting has successfully worked down under in other industries as well as health care; and John Macaskill-Smith, CEO of Midlands Health Network (an independent practitioner association) in New Zealand, gave more details of this and other attempts to develop integrated health care.
Following a recent trip over here, he remarked on the lack of strategy for developing primary care. Put this with increasing gripes from GPs about making ends meet (when we all thought they were stuffed with gold) and it is an area worth more analysis. We are on the case.
While we’d busily spent 36 hours discussing innovation in health care, our Summit ended with prodding the politicians on how they might innovate to prevent another textbook case in how not to reform the NHS.
Stephen Dorrell, Shirley Williams and Paul Corrigan (Andy Burnham and Liz Kendall on a Labour Party away day) discussed this exam question and others.
The answer... sigh... was not that hopeful, other than the need for strict induction for ministers, continuous quality monitoring, performance related pay against targets with withholds, and competition from any qualified politician. OK, I made that last bit up – but worth a randomised controlled trial?
Away from the Summit we attempted to short cut what could be a somewhat tedious discussion about rationing by publishing an analysis on whether it is time for the NHS to specify a ‘benefits package’ of what is or is not funded on the NHS.
‘No’ is our conclusion, but the report generated a lively debate and tweet flurry at a packed Royal College of Surgeons of England the other evening. Catch up on video interviews with the panellists...
Ah, and the Bill. Bumping into a demonstration outside BMA House last week I reflected that ‘to protect quality and solidarity, change is urgent’ would fit less neatly on a placard than the standard ‘Keep our NHS public’ or ‘No to NHS cuts’. Too bad.
Dixon J (2012) ‘Helping hands are better than praying lips: reflections on the 2012 Summit’. Nuffield Trust comment, 9 March 2012. https://www.nuffieldtrust.org.uk/news-item/helping-hands-are-better-than-praying-lips-reflections-on-the-2012-summit