Thursday 19 January 2012

The English Patient

Interesting bit of news today that the Royal College of Nursing has come out against the UK Coalition Government’s reforms of the English NHS (see the story here). It seems likely that this will not prevent the legislation proceeding and the changes are already substantially in hand - but it must be worrying for the Government that its plans are still unpopular with health professionals even after the legislation was substantially watered down last year. English Health Secretary Andrew Lansley (above) can't be sleeping very well and must be a candidate for the chop if the Prime Minister reshuffles.

It might be tempting for the Welsh Government to feel a bit smug about all this. In a sense the last Welsh Government went in the opposite direction to the prevailing English approach (which was certainly cross-party - the last UK Labour government was also very firmly committed to the same kind of reforms) by dismantling the last vestiges of the commissioner/provider split which never really got going in Wales both because the old LHBs were absurdly small and also because none of the successive devolved governments have really had their heart in that approach.

But there is a need for some hard thinking about this in Wales. Rightly or wrongly the prevailing model for public services in the EU and more widely in the Western democracies is moving away from top-down delivery and towards a flexible approach in which consumers can exercise significant choice and control. What is Wales’ answer to this? Can the Welsh NHS hold out with a mid 20th Century model as others develop a 21st Century model? I doubt it: we need to heed the winds of change.

However, that is not an argument for aping the changes being made in England where, arguably, the watering down of the legislation removed the opportunities for cost-efficient use of market forces but will still cause huge disruption. Further, the English plan does not really empower patients but rather GPs - and large groups of them not individual practices - so the idea that the GP can order up the English patient's choice of care package is not really a credible vision in the near future.

It would be good to see the Welsh Government open a conversation with consumers of health and social services about finding a Welsh solution to this matter - and I don't mean some kind of nebulous commitment to "listening to patients" which all governments have always pledged to do.

Interestingly the new mental health legislation in Wales could put consumers of mental health services in a good position to take more control. The universal, holistic Care and Treatment Plans which will be rolled out from June would make an excellent platform for giving patients control and choice over their care in the future.

We are a long way from handing control of the budget for delivery of those Plans to patients or their doctors or Care Coordinators (though people already have significant theoretical legal rights over their choice of social care) but in the shorter term it is vital that the NHS and local authorities start to use the Plans as the single means of justifying all secondary mental health services.

If you could match the funding to individual Plans (and I mean all the funding for secondary mental health services - about 80% of all mental health funding - not just some small change) then you would immediately have a transparent means of ensuring cost-efficiency and, in the future, you would have the means to hand over some control. However, I haven’t yet detected any sign of that kind of joined-up thinking - it's not really even on the agenda in Wales - so we’ll need to work hard to get the message across.