Last week I attended a half day conference organised by the always excellent Health Service Journal (HSJ).
The opening presentations from four HSJ journalists offered insights into the key issues – as they saw them – currently facing the NHS. Topics included finance, commissioning, integration and the general state of the acute sector.
At the end of these presentations I was filled with an overwhelming sense of despair. Such were the stories of woe, that one of the delegates – only half-jokingly – described the presenters as ‘the four horsemen of the apocalypse’. I understood what he meant. As I imagined the closing scene of Monty Python’s Life of Brian, I resisted the urge to break into song.
Now this observation is in no way a criticism of the good people at the Health Service Journal. Far from it. I have been a subscriber since 1984. Since then I have found its output never less than informative and instructive. They are only reporting life as they see it and in terms of the analysis presented at the conference… well, there was little challenge from the assembled delegates.
If it looks like a fish, and it smells like a fish…it’s probably a fish.
It was simply that the pictures painted on the day as to the current state of the NHS were so bleak, that for the first time in a long time I began to doubt my ability to make any kind of difference.
Maybe I was just having a bad day.
So I returned to the office and re-read The Five Year Forward View (5YFV). I immediately felt a little better. Within its pages a sense of positivism prevails. At the same time I stumbled across this excellent blog by Dr Diane Bell.
The subject matter of the blog immediately resonated, but it was the title for the post that really grabbed me. ‘I believe in Unicorns’.
My nine year old daughter is obsessed with the author Michael Morpurgo and has devoured all of his works including ‘I believe in Unicorns’. Indeed for Mother’s Day this year the whole family went to see the excellent stage production of the book at The Polka Theatre in Wimbledon. It was a heart-warming experience.
Now if you will excuse the pun, the 5YFV and I believe in Unicorns are very different beasts. However, in their different ways both offer hope for the future. On balance Unicorns edges 5YFV but I suspect that Simon Stevens has a slightly more difficult ‘gig’ than Mr Morpurgo.
In her blog Dr Bell is right to focus on the need for providers to collaborate around a set of shared stated aims, and for me the key word here is ‘collaborate’. But this isn’t of course a provider responsibility only. We must establish and promote a shared vision across health and social care.
I like these words ‘share’ and ‘collaborate’.
And if we accept that new care models need to be borne out of collaborative and not conflictual relationships, from a shared vision of what is best for patients and citizens, then I for one believe this good reason for optimism.
Following the release of the 5YFV I returned to an excellent publication from The Kings Fund issued in March 2014 called ‘Accountable care organisations in the United States and England. Testing, evaluating and learning what works’.
If we accept that there are indeed parallels to be drawn between the Accountable Care Organisations’ (ACO) experience in the United States and the development of integrated Primary and Acute Care systems (PACS) and Multi-speciality Community Providers (MCPs), then surely it is good to know that when thinking about how we might deliver better value for patients we are not entirely journeying into the unknown. If there are lessons to be learnt then it is best that we learn them and quickly. We should focus on the good idea and stop obsessing about their origin.
Looking at the literature it is clear to me that these new ventures will not be successful without an understanding of the data. Information is key. You need a precise understanding of outcomes and costs across the care continuum. The ACO experience is that they have invested heavily in IT systems and population health analytics. Systems and data that shine a laser like focus on populations (multi-morbid in nature) in greatest need.
I am encouraged by a narrative which has population health at the centre. There appears to be a growing consensus that our aim is to maximise value and equity for whole populations and the individuals within them. The fact that today we are even talking in these terms is a step forward.
It’s a small step and only part of the jigsaw, but if we can get this bit right (in large part the systems and data exist today) then perhaps we can make a difference.
Don’t get me wrong, unlike my nine-year old I don’t believe in fairy tales.
This is difficult stuff and none of it will be easy. But I do have hope, and I do think it achievable.
Michael Morpurgo also wrote a book called ‘Out of the Ashes’. Note to the Health Service Journal: I don’t think things are that bad yet, but I’ll give it a read anyway.