Why are still we having so many problems with the NHS? When we know some of the issues:
- We have failed to manage demand
- We have failed to prevent poor health
- We have failed to maintain and improve quality
- We have failed to control costs
- We have failed to fully integrate an link health, social care and other local services
I would add another:
- We are shackled into a dominant medical model of care
The current medical model of care based on cure is no longer appropriate for primary care where a community based social model of care would be more appropriate. There is no doubt that we have to break free and move towards solving some of our failures.
But how? Here is my suggestion:
The first step is the further merger of health and social care budgets and merging parts of the CCG with public health and the local authority.
Take social care, public health, community pharmacy, optometry, dentists and all community care providers. Add all of the practice nurses currently working in general practice managing LTCs and roll them into a new ‘primary and social care function’. Go one step further and integrate community mental health services. And then build links through communities to other public service providers, including police, fire and criminal justice. Give them the patient list and make them responsible for providing all day to day health and social care needs for their communities. Employ a small range of community specialists to supervise long term condition care which will be delivered mainly by pharmacists and nurses within fully integrated teams. Make this service 24/7 and responsible for providing/commissioning all services.
Integrate general practitioners with secondary care and tertiary care to create a medical system where patients can be referred for diagnosis and initial management through local teams of generalist and specialist doctors. Something swift and effective – a one-stop shop wherever possible. Rationalise hospitals to create specialist centres which work on a hub and spoke mechanism with local generalists. Scrap payment by results and commission all of this on a bloc basis with incentives based on quality care and outcomes.
Drastically reduce the quangos and arms-length bodies and make employers legally responsible for standards and care.
There that sounds simple