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Power to the People: The mutual future of our National Health Service

The National Health Service is at a critical juncture in its long and illustrious history. Tighter public finances brought about by the most significant programme of fiscal contraction for a generation, together with an ever-ageing population, mean that the current system of healthcare enjoyed by all in England is simply unsustainable. Add to this the stark rise in those suffering from complex and long-term conditions, which are also closely associated with ageing, and the system under which our health system functions will clearly need to be radically reformed. Indeed, long-term conditions will alone bankrupt the NHS if a more effective means of tackling these conditions in not devised, with a funding gap of £19 billion just as a result of these chronic conditions projected within the decade if health spending remains frozen in real terms.

 

The National Health Service is at a critical juncture in its long and illustrious history. Tighter public finances brought about by the most significant programme of fiscal contraction for a generation, together with an ever-ageing population, mean that the current system of healthcare enjoyed by all in England is simply unsustainable. Add to this the stark rise in those suffering from complex and long-term conditions, which are also closely associated with ageing, and the system under which our health system functions will clearly need to be radically reformed. Indeed, long-term conditions will alone bankrupt the NHS if a more effective means of tackling these conditions in not devised, with a funding gap of £19 billion just as a result of these chronic conditions projected within the decade if health spending remains frozen in real terms.

ResPublica

Unfortunately, the NHS, which was established to combat acute diseases like tuberculosis or polio, is simply not designed to treat those with the modern chronic conditions associated with ageing and flawed lifestyle choices. It has long been proven that the most effective way of treating these more complex conditions is to provide whole-person care that caters for the needs of the patient in a holistic fashion. For such care to take place, the delivery of healthcare needs to be organised in an integrated fashion so that it is able to cope with the complex and multivariate causes of modern chronic conditions.

The healthcare system as it is currently structured is, however, far too bureaucratic and fractured to cope. The majority of NHS resources are locked-up in hospital settings and little regard has hitherto being given to more integrated forms of healthcare. As such, the type of holistic care needed to combat long-term conditions, and the chronic diseases associated with ageing, remains a distant reality if not a dream.

Having such a fragmented provision of healthcare compounds problem upon problem, increasing the demand that derives from a failure to deal with an issue effectively the when first encountered. Recent analyses suggest that as much as 80 per cent of all A&E submissions were admitted incorrectly due to this 'failure demand', and that many should have been referred to more appropriate settings outside of hospital. Given that almost half of all hospital spend is on A&E, not delivering holistic care has clear health and financial consequences.

In light of the issues surrounding service fragmentation in the NHS, new institutions and structures will need to be installed that deliver better integrated care. Yet the e is a noticeable dearth of practical solutions on how to bring about such a transform tion. Most purported solutions either espouse further state control, with all the added bureaucracy that comes with this, or a more prevalent role for the private sector, which risks further service fragmentation through the cherry picking of those most wealthy of patients to the exclusion of the poorest. Neither option alone is a sufficient solution to the problems associated tith the chronic conditions of the future, nor can they describe how a seamless NHS could be instituted.

This report argues for a more balanced solution that exemplifies the positive traits of both the public and private models We believe that mutualism could perform this hybrid role. Health mutuals are owned exclusively by patients, and are democratic and benevolent. As such, they are in a perfect position to offer or co-ordinate integrated care in a collaborative fashion. Not only this, all mutuals operate in the competitive space and could increase patient choice through the imposition of further competition.

Since the introduction of foundation trusts and the emergence of NHS spin-outs, mutualism has had a significant foothold in the NHS. But a mutual model has yet to be developed that can perform the integrating role required to partner and group disparate service providers to deliver whole-person care. One type of mutual organisation that would be ideally placed to play such a role would be the friendly society. Prior to the creation of the NHS, friendly societies dominated the financing of healthcare in England, and have a long history of excellence in the health sector. These mutuals organisations already deliver or facilitate healthcare on behalf of their members in a holistic and integrated fashion, and could perform a much needed integrator role in the centre of the NHS.

This new, mutual-centred model of integrated care would, under the plans detailed in this report, be completely funded within the current efficiency commitments established under the Quality, Innovation, Productivity and Prevention (QIPP) programme, and would realise further savings of £4.5 billion through providing more integrated and community-based services. As part of this new system, a revised role for Monitor would also need to be developed, with a more pro-active role envisaged for the regulator that has integration at its heart.

This system of whole-person, joined-up care would undoubtedly improve the patient experience, improve health outcomes and be much more cost-effective. In order to achieve the integrated system of healthcare outlined in this report, and to promote the mutual organisations needed to facilitate this integration revolution, we recommend that Government and the industry adopt the following eight recommendations.

 

Get the full report here.

 

Source:
ResPublica

 

 

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The Operating Theatre Journal, OTJ, is published monthly and distributed to every hospital operating theatre department in the UK. The distribution includes both the National Health Service and the Private Sector.

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