Transforming the delivery of health and social care: The case for fundamental change

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The UK has the second highest rate of mortality amenable to health care among 16 high-income countries, and evidence shows that variations in health outcomes between social groups are widening.

This paper (the first in a series on the future of health and social care in England) explores how the current health and social care delivery system has failed to keep pace with the population's needs and expectations. It argues that incremental changes to existing models of care will not be sufficient in addressing these challenges and that a much bolder approach is needed to bring about innovative models that are appropriate to the needs of the population and are high quality, sustainable and offer value for money.

Key findings

Services have struggled to keep pace with demographic pressures, the changing burden of disease, and rising patient and public expectations. Too much care is still provided in hospitals and care homes, and treatment services continue to receive higher priority than prevention.

  • The traditional dividing lines between GPs and hospital-based specialists, hospital and community-based services, and mental and physical health services mean that care is often fragmented and integrated care is the exception rather than the rule.
  • Current models of care appear to be outdated at a time when society and technologies are evolving rapidly and are changing the way patients interact with service providers.
  • Care still relies too heavily on individual expertise and expensive professional input although patients and users want to play a much more active role in their care and treatment

Policy implications

National and local leaders need to take a strategic view rather than focusing on short-term fixes designed to preserve existing services.

Implementation of new models of care will involve: decommissioning outdated models of care; supporting NHS organisations to innovate and adopt established best practices; recognising the potential of new providers as an important source of innovation; developing a culture that values peer support for learning and innovation; encouraging players at the local level to test new models of care.

More on health and social care delivery

Comments

Graham Brack

Comment date
06 September 2012
I think someone must have been reading my notebooks. I agree with almost all of this and have been arguing so for some time. My only gripe is that the role of pharmacists in widening access to primary care and self-care isn't mentioned.

Richard Melton

Comment date
06 September 2012
Graham - perhaps that is because most pharmacists are profit-driven shop keepers!

Martin

Comment date
06 September 2012
That kind of sniping is precisely what is holding the debate and action back. Collaboration is the only way forward.

Nick Pahl

Position
CEO,
Organisation
British Acupuncture Council
Comment date
06 September 2012
Again, as per my comment on Chris's blog, I firmly believe that debates about health policy and structure in the future ignores the role that health professionals such as acupuncturists have to offer cost-effective and personalised healthcare in the UK. It's clear that there is demand from the British public for acupuncture as a treatment and that it offers holistic, personalised care that improves wellbeing outcomes for patients. There are many examples from around the country where our members have successfully worked both inside and alongside the NHS to meet patient needs.

Jo Brown

Organisation
PCAH
Comment date
06 September 2012
I agree with most of this but would suggest that when the best care is identified it should be incorporated into the NHS and free to all patients. So if the most effective care currently is to be found within the private integrated medicine clinics, why aren't the same care principles applied within the NHS? What we really do not want to see is the takeover of care dominated by the international Big Pharma whose overriding concern is increasing profits by getting as many patients as possible permanently prescribed with multiple drug regimes from the cradle to the grave.

John Kapp

Position
Director,
Organisation
SECTCo
Comment date
07 September 2012
I strongly agree. I have just served the chairman of my CCG the following FoI question: 'What plans have you to stop breaking the law and grant patients their statutory right to NICE-recommended complementary therapy within 18 weeks if their doctor says it is clinically appropriate, by opening up the market to third sector providers, as bid for on 27.7.12 by SECTCo to the Community Mental Health prospectus (see sectco.org) ?'

John

Comment date
07 September 2012
There are some valid points here but , sadly, these are outweighed by several inaccuracies and misconceptions of primary care. Collaboration is the way forward and I think those complementary therapies that have evidence they are effective should be used more often.
I do find it very sad to see a report like this using the phrase on page 20 'there are concerns about the quality of out of hours care'. Where is the evidence for this or is this just research by reading the Daily Mail?
There have been tons of similar reports and like them this will go the same way and be forgotten. Good publicity for the Kings Fund, at least! Or was that the only purpose?

SJ Burnell

Comment date
07 September 2012
Every Person, Purpose, & Process needs to be focused on & aligned with the interests of Patients & the Public. Too often, we read about the consequences of this not being the case.
How do we get the people with the Power to give the people with the Ability the Tools, Time, and Motives they need to make the required changes?

Julie Ann Racino

Position
Freelance Writer,
Comment date
10 September 2012
Based on my 30 plus years in the fields, I'd say the incremental change is related to minimal change at the margins. Sunday afternoon, I was reviewing the mid-1990s home of my own initiatives in the US, and indeed in practically an instant, the states were at guardianship and conservatorship of the funds for home purchasing; most of the group, of course, was on inheritance of the home or the parents acting as the guardian of the person. I also reviewed a Hispanic literature article on homeownership, and of course, no disability in the article; and no Hispanic findings (e.g., large proportion of immigrants) in the disability article...with that coalition start, it's amazing any change happens at the cross bridge. It's constant...integrationists act segregationally on integration funds...at all the high US finance agencies in states on that one.

Helen Caton Hughes

Position
CEO,
Organisation
The Forton Group
Comment date
12 September 2012
It's 50 years since the groundbreaking work on 'paradigms' was written (T. Kuhn, The Structure of Scientific Revolutions, 1962) but it's key messages remain. When enough anomalies are recognised in the current paradigm, it will exist in a state of crisis - and even conflict - until a new paradigm emerges. New Paradigms are often identified outside of the existing, dominant structures and ways of thinking.
Healthcare as we know and practice it in the UK is, as this report indicates, out of date scientifically and economically.
Even the way new ideas and approaches are researched and tested is out of date: driven by economic silos rather than cross-organisational, cross-sectoral, or even cross cultural approaches to R&D.
My personal commitment is to support better leadership - in the NHS and elsewhere - as I believe that transformation starts with each one of us. I'm not referring to position or profession: we're all taxpayers and it's our financial contributions that are being spent (nay, wasted) here.
It takes courage and determination to transform services - as well as the vision to see that there are many better ways and new possibilities.
I believe that we can create affordable health services, free at the point of delivery - globally - given sufficient courage and determination.
As the Huffington Post blogger, Mitch Ditkoff, says "If not YOU, who? If not NOW, when?"

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