Monday, 22 October 2012

Carpet Bombing?

David Nicolson, the CEO of the NHS has been waxing lyrical about the carpet bombing of privatisation. Now as I know David is not opposed to choice and competition in the NHS and the remarks are too easy to take out of context.

But I thought it worth a response so did an article for HSJ which I repeat here:

I’ve heard much apocalyptic language used about competition in public services, but Sir David Nicholson’s graphic description of ‘carpet bombing’ the NHS is certainly a new one. It’s clear that Nicholson is not actually suggesting we drop any extension of choice and competition in the NHS. Unfortunately, the danger of such language is that it is used to drown out sensible debate.

It is now almost impossible to have a discussion on the role of choice and competition in health without it descending into name-calling. It has become a fact-free zone, a playground for ideologues and politicians. This risks entrenching an already overly risk-averse service, and marginalising those who argue for new approaches and innovation. It pushes charities and social enterprises to the sidelines, when we ought to be central to new ways of working. Nicholson’s comments could add to an atmosphere which risks freezing out the innovators we need, although I'm sure that is not his intention.

The NHS is, in fact, in no danger of ‘carpet bombing’. The independent sector amounts to a mere 5% of total provision. There is no bomber command of big multinationals waiting to demolish our NHS. There is, however, an army of third sector bodies who want the chance to show that they can provide services that are more cost effective, and better suited to the needs of patients, citizens and communities. Why not use them?

There is a real danger is that the shortage of rational debate will lead the health service to sleep-walk to financial disaster. The NHS must not only meet the “£20 Billion Challenge” but respond to the continuing need to rein in public spending over the next decade. The NHS cannot be isolated from the spending realities that other public services have to face up to, nor can it avoid the challenge posed by demographic and lifestyle change. It must embrace new ways of working, and that means making the most of new providers with ideas for doing things differently.

The frustrating thing is that we know there are new approaches on offer, if only the NHS would commission them. When demographic change means bigger numbers of the elderly needing health and social care, why do we not commission third sector organisations that prevent unnecessary admissions to hospital ? When we know that the vast proportion of the health budget is spent on long term conditions why do we not commission the very organisations ( Diabetes UK for example) that provide the support and advice needed to manage conditions outside hospital? Why do people die in a hospital bed when they want to die at home or in a hospice? Why do we not spend more on preventing ill-health? Our society has changed enormously since 1948, but our approach to healthcare delivery has not. We continue to deliver a service dominated by hospitals and the professionals who run them.

For a simple example of why we need to involve a diversity of providers in health care, look at care for the elderly. The British Red Cross provides wonderful support to help older people re-adjust to life at home after a spell in hospital. For instance, after a hospital admission resulting from a fall, volunteers transport the patient home, settle them in, advise neighbours or relatives of their return, help prepare a meal and make a further home visit the next day to ensure they are safe and well. Simple steps such as this not only make a huge difference to the quality of the patient’s experience of care- they also have a very significant impact on rates of readmission, leading to real financial savings. This is the kind of approach that NHS commissioners all over the country should be embracing.

Research by the Nuffield Trust and LSE has shown how strengthening choice and competition can improve quality. Clearly the process must be carefully managed and regulated, but to ignore the contribution that new providers can make is both short-sighted and damaging.

We need to move the debate from whether or not competition works, to how best to maximise the benefits whilst minimising the risks. The country's charities and social enterprises are ready and waiting to provide innovative, cost-effective, patient-centred services. Let's commission them. Otherwise we risk jeopardising the very future of the NHS.

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