It’s that time of year when the great and good send out their New Year messages i.e. there’s not a lot of news around in late December and there’s a good chance that a punchy opinion could make the headlines.
This is exactly what Mike Farrar achieved this week. Mike who? You know, the head honcho of employers’ organisation the NHS Confederation.
He says political and healthcare leaders must in 2012 persuade public to let go of “hospital-or-bust” model of care and failure to do so could lead to a potential loss of confidence in the NHS.
Setting out his top issues for 2012, Farrar says resources must shift into community-based services, early intervention and self-care.
NHS leaders believe that at least 25% of patients in hospital beds could be looked after by NHS staff at home, Farrar says. Political and NHS leaders need to be “honest about the issues, bold about the solutions and decisive in taking action”.
They must offer the public a compelling vision of how services can be better after the changes. They must avoid the traps of focussing exclusively on the closure of some hospital services and failing to explain how the public would benefit overall.
The NHS is already trying to make £20 billon worth of efficiencies by 2015 in order to cope with a flat budget and rising demand. But Farrar says the economic backdrop suggests that the age of austerity will now go on even longer, making the task more urgent.
He says: “We have had a lot of talk about changing services but 2012 must be the year we convert talk into action. It feels like the focus is on everything but the thing that would make most difference.
“Hospitals play a vital role, but we do rely on them for some services that could be provided elsewhere. We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self care. There is a value-for-money argument for doing this, but it not just about money and the public need to be told that. This is about building an NHS for the future.
“Care would be better for frail patients who would have fewer crises, shorter hospital stays when they need them, and more time in the comfort and safety of their homes. There would be opportunities to improve safety through consolidation of specialist services. There would be major potential to deliver better value for money and keep the NHS on a sustainable footing. We all know that quality of care will fall victim to a financial crisis.”
Mr Farrar identifies four factors that would help bring about change:
1. Strong political leadership - politicians have failed to support the NHS even when the case for change has been clear.
2. Strong clinical leadership - the voice of clinicians will be more powerful than ever under the new system but they must not be set up to fail through lack of support.
3. Changing how health services are paid for - perverse incentives often mean it may not make financial sense to provide care out of hospital even though this may be best for patients.
4. Listening to the public - NHS must always listen and be prepared to change course when it is getting something wrong.
The task of shifting public and political opinion on change is one of five key challenges for the NHS that Farrar identifies for 2012. The others are:
- Coping with unprecedented financial pressures
- Addressing concerns about the quality of care, particularly the dignity of care of older patients and the monitoring of safety
- Implementing government reforms to NHS structures, minimising distraction and loss of momentum
- Resolving the long-term funding of social care, with a failure to tackle this issue having a major impact on patients and NHS services.
Farrar says: “The NHS absolutely must rise to these challenges. Those doing the day job however face major pressures in trying to keep the NHS’s head above water. They will be trying to stop waiting times getting out of control. They will be focusing on making all the new structures work as a result of NHS reform. There is a real danger of distraction.
“We must not allow that to happen if we want 2012 to be a success.”
The other New Year’s address which caught the eye was that of Dr Brian Keighley, chairman of the BMA in Scotland, who warned that continued attacks on the medical workforce’s terms and conditions, could risk ‘compassion fatigue’ amongst NHS professionals and lead to the long term damage of the NHS.
He said that politicians should not seek to blame doctors as part of the problem but instead “look to us as part of the solution” and urged them to work more closely with doctors to identify ways to overcome the financial challenges facing the NHS in the year to come.
“It is disappointing that over the course of the year, doctors have come under repeated attack on several fronts. Their contracts are being devalued and undermined by NHS employers and now politicians are attacking the NHS pension scheme. It would appear that our political leaders perceive these to be the solution to the country’s national deficit.
“While this approach might deliver some savings in the short term, it will, in the longer term cause damage to patient care and the loss of doctors from the NHS as many may choose to retire early. The NHS is nothing without its staff and right now with pending budget cuts, pressure on boards to make further savings, and staff cuts on hospital wards, doctors have less time to spend with patients and their goodwill is being pushed to breaking point.”
Amen to that. Neither are the most uplifting New Year messages ever, but both set the current challenges in context.
