This paper was originally published in March 2011. It was last updated in June 2015 to reflect changes in the NHS.
Health care commissioners will need to deliver a sustainable system in the face of the most challenging financial and organisational environment seen in decades.
They must shift the current emphasis on acute and episodic care towards prevention, self-care and integrated and well co-ordinated care to cope with an aging population and increased prevalence of chronic diseases. And they will need to direct resources to the patients with greatest need and redress the 'inverse care law' by which those who need the most care often receive the least.
The new NHS from 1 April 2013
The organisations commissioning health services in England changed radically in April 2013. Clinical commissioning groups (CCGs) are now responsible for the majority of the NHS budget, controlling around £69 billion in 2015/16. Public health budgets of £2.8 billion have transferred to local authorities (although this figure does not take into account the in-year budget cuts to the public health grant of £200 million announced in June 2015, or the funding that will flow to local authorities due to the transfer of significant NHS responsibilities from October 2015). NHS England is responsible for commissioning primary care (£12 billion) and specialised services (£15 billion), largely through its 4 regional teams and the sub-regions that sit beneath them.
As of April 2015, in most parts of the country NHS England shares these responsibilities with CCGs through co-commissioning arrangements, although the extent of delegation varies between CCGs.
Now day's health care system is one of the most sustainable and challenging system in the society through which people are getting reliable source of health care service. So in order to transforming our health care service we need to follow certain instructions from here.
1) Unsurprisingly as clinicians you hardly mention the (informal) carer. More care will take place in the community - the hospital at home - so more training and support needs to be given to the 24 hour care provider who can directly improve self-management / emergency trips to hospital / medicine management / etc.
2) Why do you forget that the mentally ill actually have shorter lifespans than the physically ill so why no suggestions in 5 to improve systems for checking the physical health of those with mental problems
3) the real debate ought to be should we spend so much money on expensive attempts to lengthen life (often for very limited return) when perhaps we should simply focus on making our remaining years more worthwhile e.g. the young disabled, physical and mental?
Take away all the fanciful government rhetoric and it comes down to money/cost rather than the needs of the patient or should i say the user. I predict that patients across the country will see their treatment curtailed in someway or other.
This paper focuses on processes (what needs to be done), without addressing the information needed to make better decisions. Given the lack of data about patient-perceived outcomes and experience with real-time feedback to patients, clinicians and managers, it is surprising to see that the provision of useful key performance indicators for each of the 5 quality domains is not prioritised. After all, you can't safely improve what you are not measuring.
Comments
2) Why do you forget that the mentally ill actually have shorter lifespans than the physically ill so why no suggestions in 5 to improve systems for checking the physical health of those with mental problems
3) the real debate ought to be should we spend so much money on expensive attempts to lengthen life (often for very limited return) when perhaps we should simply focus on making our remaining years more worthwhile e.g. the young disabled, physical and mental?
Add your comment