Rx: Urgent -get out of the Dark Ages

Future Forum 2 – not a sequel but the next round of recommendations from the great and the good that began last summer – has reported, with further insights on integrated services (along with information, by far the most important theme), education and training for the healthcare workforce, information for clinicians and patients and the NHS’s role in the public’s health.

Promoting individual better health and wellbeing

Note this is not “public health”, but THE public’s health, which is quite a different thing as it focuses on what individual health practitioners, particularly the GPs, nurses and therapists working in primary and community care outside of hospitals, could and should do with individual patients and clients to promote individual health and wellbeing.

This happens already in many places, of course, but not widely enough.  In the stone-age days when I qualified in health promotion, “health education officers” tried to do this and the clinical people left us to it as they got on with treating big toes, ulcers or cancer, relatively oblivious to the complex lives the conditions were attached to.  Now health promotion is (or should be) everyone’s business.

Whether the public will see it like that and take kindly to being questioned about lifestyle  - smoking, diet, exercise, alcohol consumption, even sexual activity perhaps?  - when they see the doc (or the midwife or health visitor) for something else remains to be seen.  But it’s a start to “making every contact count”, provided the workforce has the right attitudes and skills, which many probably don’t.  They will need help seeing it as part of their core role, not a time-consuming add-on.

Integration demands full implementation

“If implemented in full these proposals will make a real difference for patients and service-users. Among other things they will help tackle the curse of fragmented care and lift the NHS out of the information dark ages.”

So said sage Jeremy Taylor, CEO of National Voices and a FF stalwart.  That’s the catch – “if implemented in full”.  Warm words and good intentions won’t cut it.   Chris Ham, Kings Fund CEO, nailed this:

“Our concern is these are warm words and good intentions but in practice they won’t be as much as we would like. There are not enough specific actions the government is committing to, which would give more confidence this was a real watershed.”

There is no compulsion to deliver integrated services in the dog’s breakfast that is the current Bill.  Unless government fixes that urgently and obviously by instituting the measures  to promote integration we have already championed, I cannot see the FF’s vision for integrated services becoming reality.

No information no integration

National Voices did a submission to the FF on what patients, service users and carers want from integrated care.   Read it. It stressed that integrated care could not work unless information flows worked -  and by general consensus we are in the “dark ages” as far as information is concerned in the NHS.

One of the problems stems from relinquishing data control to IT geeks.  In Jeremy Taylor’s colourful phrase – he chaired the information workstream on FF2 – the information agenda has been “ceded to IT people, who had disappeared up their own technological complexities”.   We concur  and have argued many times for people to own their own data and for “data intermediaries” – specialist nurses working with people who have long term conditions for instance  - to partner with patients and carers for that purpose.

A snag for the moment is that mentioning IT and NHS in the same breath has ministers reaching for garlic, a cross and a stake. The idea of another NHS IT project monster  is anathema, but there is much that could be done through EMIS is everyone in primary care used it to its full potential and shared data with patients.

New Bill needed

Taking the recommendations in FF1 and FF2 together, we have all that needs saying about what sort of NHS England needs.  So why, then, is the Government – having accepted with alacrity all the FF’s recommendation – clinging stubbornly to the wreckage?  Their behemoth of a Bill is currently mired in the parliamentary process.  It is a sow’s ear of legalese that no amount of tweaking is going to turn into a silk purse of convincing narrative for change.

Throw the wreckage overboard and rewrite the legislation around implementing the FF1 and FF2 recommendations. If Mr Lansley is really listening to the FF “listening exercise” and has the foresight and courage to do what is needed, then he would have a credible reform platform, and a narrative to support it, on which we would all be pleased to stand with him.

 

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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