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  • Current models of care appear to be outdated at a time when society and technologies are evolving rapidly and are changing the way patients interact with service providers.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Implementation of new models of care will involve: decommissioning outdated models of care; supporting NHS organisations to innovate and adopt established best practices; recognising the potential of new providers as an important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

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?

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) ?'

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.

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.

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.

Richard Melton

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

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.

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