Does the answer to sustainability in the NHS come as equally from quality as it does from efficiency?
As those in Westminster bring the NHS and health care to the forefront of their election campaigns, we have heard a lot about increased burden; the huge efficiency savings needed; the pledges of additional funding; and the struggle to deliver consistent, high quality care. Yet none of the rhetoric has touched on how to tackle the underlying challenges that are driving these pain points.
There has been no substantive commentary from any party on how to tackle an inadequate staffing pool; how to deal with the health and social care demands of an ageing population; and how to support longer living, combined with increases in the number of those living with long-term conditions.
Those living with long term conditions often require some of the most costly and complex care packages offered across health and social care systems. Whilst the conditions themselves can be defined (or sometimes unfortunately just labelled) from a clinical perspective, the challenges and needs of those living with a long term condition, or caring for someone that is, are unique to the individual, their family and/or their carers. In this way they become the experts on living with the condition. Yet in general, policy makers are still not delivering on plans to create and develop opportunities that routinely involve these groups in the design and delivery of care pathways. Nor do they systematically invest in developing further national level initiatives that support an understanding of people’s care needs and experiences.
In areas where this is happening the results have been encouraging, and the potential impact is significant in terms of both the improved quality and the increased efficiency and effectiveness of services. Examples include:
- NHS England recently supporting approaches taken by NHS acute trusts like Blackpool Teaching Hospitals NHS Trust to use the Always EventsTM initiative to co-design more effective and efficient care processes that improve care for specific patient groups, or in specific care settings. There are now plans to support the roll out of this across the NHS.
- The NHS national survey programme that regularly gathers general feedback from patients about the care they receive has been used to good effect to improve experiences of many key transactional elements of care in the last decade. However, the results could be deemed as being relatively under-utilised. For example, each of the national survey programmes (outside of the mental health survey) offer respondents the opportunity to self-report whether they are living with a long term condition, or multiple conditions, and the nature of these. This means the results could be used to represent, at a local and national level, the care experiences of various groups. This would be a powerful and valuable asset in starting to identify how to deliver services that better meet care needs within a resource poor environment.
- At a local level, numerous engagement and involvement projects are having a strong impact, with provider, commissioner and third sector organisations coming together with patients, service users and their families to design and deliver higher quality, lean care services. The recent national Patient Experience Network (PEN) awards highlighted many of these examples, with organisations such as Positively UK recognised for their contribution to supporting those living with HIV through a peer support model that improves emotional wellbeing; health literacy in the field of HIV; and the ability of those living with HIV to access the correct service when they need it. More broadly it supports local commissioners to involve patients in the commissioning pathway and improves effectiveness and efficiency of commissioning decisions.
If the message that Westminster wishes to give to citizens is that “you and your health matters”, and if we are to realise the reality of a sustainable NHS, there must be a unanimous commitment from all parties to address the root cause of capacity and funding challenges. A clearer and stronger articulation of how they will move from discussion that revolves purely around funding the NHS to the advocacy, support and commitment to develop the innovative and sustainable solutions that are needed to tackle the complex issues it faces.
In healthcare it is often said that all experiences matter, but it is my view that actions speak louder than words, and in committing to this approach we might just find that people’s experiences, and our ability to use them in the design and delivery of health and social care, releases the possibility of long term sustainability and quality.