Ken Hesketh, Chief Executive of Benenden Healthcare looks at what the new coalition agreement means for UK healthcare provision.
The recent coalition agreement outlined the new Government’s intention to increase democratic participation in the NHS with the aim of making it more accountable to the patients that it serves.*
Underpinning this commitment is a call to drive up standards, deliver better value for money and support front line delivery of care. As we know, although the NHS budget is “ring fenced” by the Government and will be spared cuts to reduce the deficit in the public finances, the Department of Health (DoH) is still tasked with finding efficiency saving of £20bn this year.
In order to balance these objectives, the DoH is championing a number of new working practices that combine traditional Conservative thinking on markets, choice and competition with Liberal Democrat and Cameronian Conservatism beliefs in advancing democracy at a local level.
These include: stopping top-down governance of the NHS, reducing duplication and the resources spent on administration services by one third. Transferring greater power to doctors and nurses, allowing them to use their professional judgement about what is right for patients. The Government also wishes to give every patient the power to choose any healthcare provider that meets NHS standards, with NHS prices. This encompasses independent, voluntary and community sector providers.
Cameron and Clegg are attempting to square the circle of not totally remodelling the NHS whilst at the same time transferring power downwards increasing the number of providers and increasing efficiency. With all this in mind, it is going to be a careful balancing act for the Government to avoid implementing any kind of change programme that supports increased patient choice and empowered front line staff
Issues
The ConLib coalition is seeking to give patients more influence over decisions about their care, offering them the right to choose the GP they want regardless of where they live; rate hospitals and clinical staff according to the quality of care received; and take charge of their own health records.
With this in mind the NHS and other healthcare providers must prepare for a new system that welcomes transparency and accountability of efficiency and quality of services.
It is early days (the Government is not yet a month old), so we are yet to find out how this model will be established, rolled out nationally and monitored. It is likely to mean streamlining of existing administration protocols within the healthcare system, with expectations that many processes will become digitalised and comparative information (by cost, convenience and quality levels) readily available online. Some may argue this is already happening – it is certainly in tune with what patients want and not unreasonable in the 21st century - but it will require updating of IT systems.
The move, based upon the principles of consumer choice, fits with general public’s expectations, as it is used to choosing its service providers based upon the quality of product and customer service on offer. Such criteria are currently routinely used by the general public when it chooses banking; insurance; and utility service providers. Such principles are applicable to health and wider care services but do represent a cultural shift from a monolithic, one size fits all, supplier mind set.
Such a change (which is already well under way in some areas) does offer many opportunities for the independent and voluntary healthcare sector to get further involved in the provision of public health services. The time is now ripe for these providers to support the NHS and make it more efficient and improve the services it offers, by finding innovative ways to relieve existing pinch points and plug some of the gaps in NHS services, without necessarily charging full private medical insurance fees.
Challenges
Education and communication will be the key to achieving a workable and effective model that avoids misuse, and ensures healthcare professionals remain protected If health professionals are bypassed and change is brought in too quickly there is a danger this approach could produce strained relations with staff and industrial disputes.
It will be imperative that healthcare professionals, remain a key part of decision making alongside greater patient power and rights.
The latest reforms suggest a step-change in how the NHS will be run, moving away from a centralised command and control structure with many micro targets handed down to ‘those on the ground’ to, a more inclusive, local-centric, almost a “shared ownership” approach where NHS staff retain some decision making powers and autonomy.
Independent research by the Employee Ownership Association has shown that most organisations experience a productivity boost when shared-ownership models are introduced.** These models appear to positively impact on staff turnover, absenteeism, company loyalty and performance – as employees have more motivation to succeed and feel part of the organisation and not merely a number in a huge organisation.
Benenden Healthcare believes that this shared ownership, mutual ethos amongst staff has a direct impact on the quality of patient care. It is our view that the promotion of existing and establishment of new mutual organisations, in all their guises, can only serve to promote a more active society. We therefore cautiously welcome the new Government’s plans for the NHS - but as ever the devil is the detail!
Change is inevitable as technological and scientific advances are being made all the time. The old structures, although delivering, on the whole good, care for patients, are nonetheless creaking under the strain of demand and technological change.
What is clear is that patients and front-line staff will need to recognize and accept that reform is on the way. We must work together to ensure that this evolution of the NHS does not undermine its core purpose – to provide universal and quality healthcare for everyone.
Footnotes
*The Coalition: Our programme for government, HM Government
**Employee Ownership Association, 2007