Clinical excellence awards should be used to incentive consultants to provide whole person care, recommends a report commissioned by the Labour party.
“At the moment doctors are better rewarded for treating patients as if they have individual parts of diseases and not the whole person.
“This encourages doctors to stay within the old model of care and not treat the whole person,” says the document produced by the Independent Commission on Whole Person Care.
Chaired by Sir John Oldham, a GP and former Department of Health national director, the report is expected to influence Labour proposals for health and care in the run up to the 2015 general election.
The Commission found that while there is agreement regarding the necessity to change towards coordinated care, care today remains fragmented and episodic and does not meet the needs of patients.
The people who now need the most care are older people with long term conditions, who will need personalised, co-ordinated care for the rest of their lives.
The Commission argues for a “radical new approach” over the next Parliament, to re-work the health and social care system to meet these needs. “Behaviours will have to undergo radical change, with the needs of one person being addressed by health and social care staff acting as one team, working for organisations that in turn behave as one system,” it says.
But the report stresses that these changes should be introduced without a complete reorganisation of the structures of NHS and social care. “For too long health and social care have been considered separately. They are inextricably linked. However we do not believe the answer includes yet another major structural reform at this time,” says the report.
The Commission recommends that clinical commissioning groups should be retained and largely keep control of their budgets.
This contradicts proposals outlined last year by shadow health secretary Andy Burnham for the £60 billion NHS budget to be transferred to health and wellbeing boards putting elected local authority members instead of doctors in charge of an integrated health and social care budget.
However the report does suggest here should be a greater role for health and wellbeing boards having “the collective system leadership for services for people with multiple long term conditions, disability and frailty”.
– Professional training bodies should put much greater emphasis on multidisciplinary working.
– More generalist training should be developed for doctors balancing the trend towards increasing specialisation.
– Patients, families and carers should be given meaningful role in shaping coordinated care around their needs.
– Patient organisations should play a full role in reorienting the whole system around the real needs of the population.
– Commissioning plans should use local resources, health and social care together (the “locality pound”) to deliver outcomes defined by the people using the services.
– NHS England should be renamed Care England, and made the “strategic lead” of health and care, ahead of regulators and the NHS Trust Development Authority.
– An internationally connected research centre should be set up to manage people with complex needs.
– In the first year of the new Government a national conversation should be held about the scope, provision and funding of health and social care together.
Dr Mark Porter, chair of BMA Council, commented: “The greater integration and coordination of health and care services proposed in this report would not only benefit patients, by ensuring they have access to the right care for their needs, but might deliver savings to the NHS in the long-run.
“The current fragmentation of services can make it difficult for patients to navigate local health and social care systems and squanders resources.
“Crucially, any new system, however well integrated, would need to ensure the existing funding gap is closed so both the health and social care needs of patients are adequately met. It will not be right to further cut hard-hit health services to backfill and extend social care.
“It is also vital that these reforms are delivered without repeating the wasteful and damaging top-down reorganisation forced on the NHS recently.”