The ‘C’ words – Gerada vs Dorrell
Posted: 3 July, 2011 by Andrew Craig
Re-entry to the real world of NHS reform (you realise I jest here) from the end of an idyllic holiday on a Greek island far away from flickering television images of rioters and burning dustbins is not a pleasant task for one’s brain. So I am grateful for some help in going back “through the Looking Glass” into what we term reality. My re-entry has been made somewhat easier by the estimable Andrew Marr whose Sunday morning programme recently featured both Clare Gerada and Stephen Dorrell voicing views on the key changes in the reform of the reforms that is meant to follow the report of the Future Forum and Government’s response.
Their respective takes on the “C” words (“competition, collaboration and cooperation”) are revealing about their take on reality. What they said helped me reconfirm my own grip on it.
First Dr Gerada (RCGP Chair): “…competition has a part to play, but the culture should be around integration collaboration and cooperation which it has been for the past 60 odd years”
Then Mr Dorrell (Commons Health Committee Chair): “….part of the issue for those who hold budgets for commissioning is to look at alternatives for delivering care which address the fragmentation which is part of the history of the health service which needs to be improved upon.”
No contest for the reality prize then. Stephen Dorrell wins hands down. Integrated services for the past sixty years or even the past ten years? Dream on, Dr Gerada. Mr Dorrell’s “fragmentation” analysis tells a sader but truer story.
If you want to hear the real story about disconnected services, just ask the thousands of people with diabetes who are not being followed up for routine checks.
Tell the thousands of people with long term neurological conditions whose National Service Framework – only 5 years old – promoting integrated commissioning and services has sunk without trace or even a remark of regret from those leading the NHS that they enjoy integrated services. Expect a flea in your ear.
And let’s not even mention the service disconnects and funding chaos around what we grandly term “end of life care” which most people still don’t receive.
The “big shout” of the Future Forum and our National Voices friends was: “integration, integration, integration”. It is about time the doctors and and other professional special interests forgot the mythology they spin so well about themselves and got on the with creating the hard reality of real integration which benefits the users who pay for it all.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.
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A couple of things come to mind from reading your recent blog Andrew. Monday morning musings I’ll give you, but tempered by a degree of weekend introspection.
Integration has, as Dorrell pointed out, long been a problem. I would say primarily because the NHS was founded on the basis of providing short-term, fix or patch-up care.
GPs weren’t gate-keepers as much as frontline defenders, keeping people away from expensive hospital care, and hospital care was constructed as simple find it, fix it, dispatch it, units. Where primary care and hospital care did interface, it was very much based on the primary care professionals handing over to their better qualified (!) colleagues in the shiny buildings, and being merely kept in the loop about what was happening to their charges.
For my mind, the problem of integration is being tackled from the wrong direction, but tackling it from the direction best suited to deliver the best results is a huge, and to the British mindset, uncomfortable solution. We, the patients, have to be the key to integrating care across care pathways. Give us responsibility for managing our care. Give us, as pregnant women already have, access to our care records. Create a sense of control, to which is connected a sense of responsibility, for managing our health (and that of our families), as being normal. I challenge the narratives that leave all of the responsibility to doctors to pick up on regularly checking people living with asthma and diabetes.
If one has a diagnosed long-term condition, then one should be taking a degree of responsibility for managing that condition. Including challenging the clinicians about their care and treatment. For me, a key to this has to be the furtherance of the self-management model, and its rather interesting that the Expert Patient CIC has been rather silent during most of the Health Bill debates.
BTW, I haven’t even mentioned shared decision-making, the personal bit of the ‘NAWM’, to which the community bit must be developed if it is to truly take flight.
Thanks Mark, good thoughts. And of course there are no votes in primary care, but lots and lots of votes in hospitals, beds, flashing and beeping equipment and docs and nurses in uniforms standing around them. People love bricks and mortar, especially shiny stuff. The Expert Patient dimension has been strangely silent I agree.