Health as a social contract
On occasion this blog admittedly feels extraordinarily negative. It is easy to criticise, especially given the constraints of detail, anonymity & space in addition to the fact that posts here are usually in response to a media event but there is good practice happening in the NHS & there are staff all over the country who are chomping at the bit to improve conditions for patients & also their working environment, a fact recognised in the HSJ last week. What can be quite often lost in the fog of war is the consensus that the status quo isn’t good enough & that more needs to be done to improve the system. Where I might differ from the current policy climate is on the direction of travel in so that this is achievable.
So what do we want from a healthcare system & is there a better way of delivering the objectives?
As a national healthcare system funded by the taxpayer, the opportunity exists to work towards a social benefit in addition to the immediate needs of the patient. In practice however, it is constrained by the limited budgets available & the structures from another century. Most healthcare is predicated on short-term measures, patching up the patient for the immediate future & getting them out of the facility as they then become someone-else’s responsibility. There is a real lack of integration in service provision so that the return of the patient to productive health is achieved at the lowest possible total cost.
This opportunity to take a holistic view of the service is what I expect from a national healthcare system instead of the current arrangements in which each individual patient contact is counted as a separate cost-centre with a myriad of unnecessary steps that reduce the immediate cost to the provider but delay the patient’s recovery & add to the total cost.
In the short term, this is one of the projects I will be working on, to design a better service (which probably exists elsewhere) & try to implement it locally within the constraints of the NHS. This might take the form of a polyclinic or an urgent care centre if those are the only options available or it might even be one of these new GP surgeries out to tender. Let us see what happens.