Dr Dan Poulter MP 11.49am
My front-line NHS experience has shown me that under the previous government, there was an increasing and damaging emphasis placed upon nationally imposed, top-down, procedural bureaucracy, as opposed to improving the integration and delivery of key frontline healthcare services.
The result has been a failure to invest properly in healthcare and social services support for the elderly, and a failure to recognise that the healthcare challenges facing inner city areas in terms of disease profile are very different from those facing rural communities.
The single biggest challenge facing the NHS is how to meet both the human and the financial cost of looking after our growing elderly population.
We know that by 2033, it is predicted that a quarter of the UK’s population will be over 65, and on current projections, by 2035, the number of people aged 85 and over is projected to more than double to reach 3.6 million, and to account for nearly 7 per cent of the UK’s population. Most startling of all, the number of working age people for every state pensioner will fall from 3.2 (2008) to 2.8 (2033).
The priority must be to deliver a more integrated healthcare service that is tailored to individual patients’ needs.
In many parts of the NHS, there currently exist distinctly isolationist working practices - often referred to as ‘silo-working’.
There is the primary care silo, the hospital silo and the social services silo. Silo-working has failed patients, and has only served to drive up the cost of patient care. For example, hospitals are rewarded for treating patients for an acute episode of care - ‘payment by results’ - but hospitals are not incentivised to think together with primary care to promote better care in the community, which would avoid inappropriate and expensive hospital admissions.
Properly integrating NHS services means that we must recognise that different healthcare needs exist in different parts of the country, which requires a more tailored and locally-focused approach to the delivery of NHS and adult social services care. For example, the healthcare needs of those in metropolitan areas are often very different to those in rural areas. Lord Darzi’s super clinics may work in Islington but not in rural Suffolk.
In July 2011, the Dilnot Report was published. Among many compelling findings, it concluded that the current social care formula in the UK is simply unsustainable. Additionally, it recommended that a cap of around £35,000 should be placed on individuals paying for their care, that means tested support should continue, and, crucially, better integration of the health and social care sectors. We should welcome these findings as an objective, cross-party analysis of what is required for the future.
The previous Labour government was strong on the rhetoric of healthcare inequality but failed to address adequately the biggest healthcare inequality of all - meeting the care challenges of an ageing population.
The coalition’s NHS reforms are a step in the right direction. NHS budgets and health services will be mostly run from the community by local NHS commissioning boards, and this will help break down the funding divisions that currently exist between primary care and hospital services.
The result should be a greater emphasis on integrated, community based health services rather than acute response based medical services, or in other words healthcare that better supports people at home and prevents the inappropriate admissions that are so distressing to patients and expensive to the NHS.
The Dilnot Report makes clear that the greatest need for joined up healthcare exists in the better integration of NHS services with adult social care, but true harmonisation of healthcare service delivery in both financial and human terms will only be achieved by fully integrating the NHS and adult social care budgets in the way that they once used to be.
My consultants at medical school used to tell me that the NHS was better in the old days. As in so many other things, it looks like they were right.
Dr Dan Poulter is MP for Central Suffolk and North Ipswich and a former NHS hospital doctor specialising primarily in obstetrics, gynaecology and women’s health. He continues to practise medicine as a NHS hospital doctor part-time, and is a member of the Health Select Committee.
This is a shorter version of an article that originally appeared in the TRG’s autumn edition of Reformer, available to download here.