Stephen Dorrell, former Health Secretary and until recently Chair of the Health Select Committee, has often spoken of the need to 'reimagine' healthcare, not least because of the scale of the financial and quality challenges the NHS faces. How imaginative have we been so far?
A year ago NHS England launched its Call to Action, which inspired six characteristics of the future outlined in planning guidance for 2014-15. Local areas have been preparing strategic plans setting out how services will change over the next five years. Simon Stevens, the new Chief Executive of NHS England, has begun to set out his ideas. With a general election and subsequent spending review around the corner, it is timely for us to be reimagining health and care.
Thinking about the future
2020 may not seem far off, but a lot could happen in that time. There may be some major technological advances. After all, just 18% of us used smartphones in 2011; today the figure is 70%. There could also be major disruptions like an unexpected outbreak of flu.
In the Department of Health we are thinking about what people need and want to help them and their loved ones to live well and die well.
My vision for health and care
People should be supported to maintain their health and independence, with health professionals able to prescribe social interventions. The use of personal monitoring devices and sharing of real time data would help greatly. Coaches and health trainers can also help change behaviour.
The wider community – including employers - should encourage active lives, helping to reverse the trend in obesity.
Those with certain mental health problems or chronic conditions could be part of peer support groups, meeting in person or online. They would be given self-monitoring devices and linked via telehealth to their care team. This could help patients to manage their condition themselves. The care team would have integrated data, allowing them proactively to reach out to patients if their condition deteriorated or they were not receiving routine care. They would have a personal care plan and a health trainer if they needed it.
Those with complex health and social needs would have a named care coordinator, who would help to prepare care plans with the full involvement of patients and their carers. A local multi-disciplinary team would provide proactive care, but ideally just one person would make home visits. A direct payment or personal budget, aligned to other benefits, would be available.
Carers would be supported too, and the person’s home adapted to enable them to stay at home for as long as possible. Step up care would be available if needed locally (e.g. respite, intermediate care, and hospice).
Those with serious conditions or experiencing an acute episode or crisis would receive a prompt response. Wherever possible early intervention would avert a deterioration and prevent admission. Diagnostics would be provided as appropriate and patients helped to make an informed decision about treatment options. There would be a choice of where to go for specialist treatment, with locally available step down/rehabilitation and ambulatory care etc. Supported discharge would be available through a local team with direct access to specialists.
What is your vision for 2020?
Much of this vision is already a reality in some places. The challenge is making them a reality for everyone.
- What needs to happen to accelerate change and provide the right context for local organisations to deliver radically new models of care that will meet the needs and wants of people in future?
- Why are these models of care not already experienced by people across all parts of the country?
We not only need to reimagine health care we need to be imaginative about how we deliver the changes and improvements locally.
2 comments
Comment by Mark Treleaven posted on
Anna, I am sure many would concur with your views of an empowered and engaged population. I believe the questions you pose at the end of you article are as interesting as your thoughts.
Given the devolved decision making now in place for Commissioning these services via NHS England and CCGs what role will DH have in enabling and providing the context, for change?
Comment by simonfj posted on
Thanks Anna,
I do wish we could use take a more inclusive approach to answering your questions. It's very hard to let people know these kind of inquiries ARE going on, when these blogs are so well hidden within the GOV.UK domain.
It seems everyone is aiming for citizen participation and empowerment. But as yet the secretariats which run inquiries have yet to gain the skills. So, on one hand we have people designing individual services and informing us when they will be "delivered". On the other hand we have various secretariats attempting to gain engagement skills. e.g. http://www.linkedin.com/groups?home=&gid=8112256
But you asked what might accelerate change. So I can only point to this graphic. worldbank.org/ic4d/co-creation-of-government-services The problem for most people in public service design is that they will always start at stage 3; not stage 1. They focus on delivering an individual service rather than empowering the citizen.
We all appreciate this is cultural change - from a service being "delivered" to one where citizens (ideally) choose from a combination of "shared" services. For that to happen, the initial focus is to look at a citizen's account. It's the philosophy which is the most dramatic change. https://mydex.org/blog/2013/11/29/the-role-of-the-individual-in-digital-by-default-public-services/
Encouraging people to believe they can participate, and have some control, takes time, especially when they have been trained to believe otherwise. http://thehill.com/blogs/pundits-blog/civil-rights/214857-who-rules-america
From a (network) re-engineering perspective, the change is from (an institutional) client/server to (an inter-institutional) collaborator/cloud model network model, where things are still up in the clouds. We can seen how GOV.UK takes the central services out of the silos and aggregates them into one domain/publication. That is a logical first step.
But we are still at the point where 'Central' and 'Local' services are treated as two separate animals, when we know they must be taken together in order to be made citizen-centric. Again, we come back to the idea of a single user account. https://gds.blog.gov.uk/2012/10/25/ida-local/
Of course most silos do suffer from the idea that they are leading this charge. They have the "share" right, even if they usually believe that "the code is being written here". "How many other services hold documents or case files like this? There must be dozens of them, and all of them could benefit from the code that’s being written by the team here". https://gds.blog.gov.uk/2014/08/22/how-sharing-helps-us-improve-digital-services/
As Mike says, "Sharing works both ways". That's a little hard when everyone sets up their own blog, and is so busy writing their own thoughts that they have no time to comment on others. I keep imagining what might happen if we can get teams (in local & central gov) to share a forum rather than/as well as writing individual blogs. http://thinkexist.com/quotation/example_isn-t_another_way_to_teach-it_is_the_only/327436.html