When our PCT’s Lay Representatives Group thought about whether a change of Government would be good for their health in January this year they were pretty evenly divided. When twenty one of them gathered the day after the election, all bar one decided “no view” was now the most positive way they could answer the question.
I wasn’t surprised. Despite predictions, health and care did not become burning issues in the campaign compared to the magnitude of the national economic situation and its implications. In a time of no overall control in Parliament, our lay representatives identified/ anticipated dealing with the national deficit as the factor which would dictate everything else that happened in the public services, so manifesto health and care plans would be largely shelved anyway. The forecast of the UK’s budget shortfall overtaking both Greece and Ireland this year can’t be ignored.
Eating our savings elephant bite by bite
Our lay reps were not so much concerned with which set of health ministers were in power. But they were very concerned about how well the local health and care system worked and whether it was responsive towards users and carers. Our group were not frightened by uncertainty. They understood that prioritisation would be the PCT’s most important concern as resources reduced over the coming years. They knew that cuts would happen regardless of who was in Downing Street and if this was done insensitively at local level it would result in less choice, longer waiting for appointments, staff losses, hospital closures and less patient transport. But they also saw opportunities for making a virtue of necessity and using financial restraint to encourage innovation and allowing the local NHS to do things differently and better with their input.
Actions that Save Money
Here are some of the things we are doing to eat our financial savings elephant bite by bite which the lay reps were keen to know more about:
- GP list cleansing – our population churns up to 30% a year
- Shifting care to lower cost settings – urgent care and out patients in particular
- Long term care and case management improvements, including virtual wards
- Prevention and health promotion to keep people as healthy as they can be
- Better contract management and service reviews
- Reducing management costs and efficient prescribing
£50m+ to be saved by 2014
Above all our lay reps insisted on having a voice in local decision making and having quick feedback about what was being proposed and whether particular options were feasible or not. If that happened, a majority of them said they might be more willing to agree that change might be good for their health. In return the PCT had to deliver on its commitment to keeping users and the public informed of its plans for making cumulative savings of £54m by 2014 as our contribution to the NHS target of £20bn+ savings and 30% management cost reductions. Hard decisions about the future are simply too important to be left to the NHS or local authorities themselves in isolation from their customers.
Stop defending the devil we know
Faced with this local challenge, it is encouraging to see National Voices, representing more than 200 Third Sector bodies large and small, supporting a pragmatic approach to involvement in tough decision making. This is a message the statutory services must listen to urgently. NV’s CEO Jeremy Taylor nailed the problem in an HSJ comment this week:
“The wonks are way ahead of the general public on all this. People are not familiar with these arguments and are wary of change to their health services. They do not buy in. Look at any local service change scheme. Look at the “Save the Whittington Hospital” campaign in London against the closure of its accident and emergency unit. Look at the public reaction to polyclinics. MPs and local councillors get elected on the “save our hospital” ticket. People take to the streets in defence of the devil they know.”
You can’t blame them when the track record of statutory services is often perfunctory “consultation” on largely pre-agreed plans for service changes. People quickly see through this and consultation fatigue and fatalism take hold. Even the Independent Reconfiguration Panel has slammed “inadequate community and stakeholder engagement in the early stage of planning change”, with “health agencies not giving enough thought to local opinion on money, transport and emergency care” and “inadequate attention given to responses during and after consultation”.
Local leadership is the way
Its damning and depressingly familiar. But there is a way out of it if local leaders are brave enough to do it. Jeremy Taylor again,
“People must be informed and involved from the outset. They must have a say in the new services that replace the old. They need proper reassurance on matters of concern. This requires leadership. The clinical case for change needs to be made by clinicians (and maybe also patients). Local politicians need to be responsible. “Save our local hospital” is the line of least resistance and not always the right one.
According to Taylor, one other thing needs to change – our expectations as users of our most important public service:
“As consumers of healthcare we have been encouraged to believe that we can have it all. Now we need our political leaders to be saying something different. How about: “We have some difficult choices to make and we would like you the public to help us make them?”
MAC fully backs this approach. If this offer of local involvement is made genuinely, it’s an opportunity which lay representatives – who must be well-informed and well-supported for the task – really must not refuse.