We had an intense think-in at our Annual Health Strategy Summit this week, chewing the cud on the major elements of reform: competition, efficiency and integrated care.
Will Hutton, Chair of The Work Foundation, blew everyone away on Budget Day with an intellectual tour de force on ‘the state we’re in’ and why the health sector is part of the solution to growth.
In the future, he thought it near inevitable that some form of top-up insurance would be needed for those able to pay for benefits on top of the NHS offer; ‘flexi-security’ of jobs would be part of the deal for employees; and our tentative steps to improve choice should be turned on their head and driven entirely to keep people healthy and thus away from care.
Other highlights included Denis Cortese, a physician who had spent 40 years at the Mayo Clinic, probably the world’s most internationally recognised health centre of excellence, first as a practising physician, and latterly as its chief executive.
Speaking via a live link from Santa Fe (yes, it worked) he powerfully described the philosophy at Mayo – ‘the best interest of the patient is the only interest to be considered’.
And he went on to challenge us: if you were a diabetic ‘who here wants to be a patient in hospital?’ (no hands raised), ‘who wants to be in an outpatient clinic?’ (you get the picture). He described graphically how Mayo has increased quality and decreased costs by designing integrated services with patients at the centre by aligning the right incentives. Easy to say, hard to do. It was a powerful message which I hope at least all those in the NHS who took part in the Channel 4 three-part series with Gerry Robinson will listen to.
Of course we didn’t let the politicians off from scrutiny. The wonderfully dry Michael White of The Guardian did not give an inch to Shadow Minister for Health Mark Simmonds MP and Norman Lamb MP, Health Spokesperson for the Liberal Democrats, who outlined their respective plans for health care.
Mark in particular had a grilling from the audience about the incentives for GPs to manage hard budgets and shift care out of hospital, given the past 20 years of experience. ‘Why would they do it?’ was the prevailing question.
As a new contribution to the debate on competition, we examined two papers on its impact by their respective lead authors Carol Propper (an economist at Imperial and University of Bristol) and Zack Cooper (an economist at the London School of Economics).
These are the most extensive studies to date and show (a) that competition has increased (in fact mostly among hospitals outside the main conurbations) and (b) that one measure of quality (28 and 30-day inpatient mortality for acute myocardial infarction) has improved most in competitive areas, having taken into account case mix and a host of other factors. Food for thought.
Above all, the Summit once again confirmed the fundamental need for a transformation in the way health care services are organised and delivered in the UK, towards a ‘less is more’ philosophy and care that is delivered in radically different and patient-focused ways.
These topics are the subject of two new reports we have just published with the King’s Fund: Where next for integrated care organisations in the English NHS? and Where next for commissioning in the English NHS?. They show that achieving the efficiency we now need cannot be done by tinkering with our existing commissioning arrangements and suggest some paths forward.
No one model of commissioning or provision will do – there is not enough evidence to suggest it. The exact dose of competition needed is also obscure. We will have to learn by doing.
But, as I could not help but ponder while listening to Denis Cortese: do we have this level of thinking leadership to learn as we go? Or at national level are we in for more economic and political random shocks?
By next year’s summit, we’ll see.
Find out more about the 2010 Annual Health Strategy Summit - listen to the keynote speeches and view the presentation slides, including contributions from Will Hutton, Denis Cortese, Mark Simmonds MP, Norman Lamb MP and Jennifer Dixon, among others.
Dixon J (2010) ‘The state we're in: reflections from the Summit’. Nuffield Trust comment, 31 March 2010. https://www.nuffieldtrust.org.uk/news-item/the-state-we-re-in-reflections-from-the-summit