All together now
All together now
All together now
In no man’s land, together
The Farm — 1990
Last week the ever excellent Kings Fund published a new report called ‘Place-based systems of care: A way forward for the NHS in England‘. Within its pages there exist powerful arguments for why the ‘zero-sum game’ that characterises the current NHS (aka. The Purchaser/Provider divide) has had its day. The report pictures a future where NHS organisations are increasingly collaborating to manage the finite resources — people and money — available to them.
Unsurprisingly, Accountable Care Organisations (ACOs) get another name-check and a new world of commissioning is proposed in which commissioners — spanning wider geographies than at present — take on a strategic role for defining outcomes and measuring the performance of the health and social care system as a whole.
The language is very much one of capitated budgets where providers and commissioners work together on behalf of a whole populations. The report has much to commend it, not least for the fact there is a recognition here that the existing system in which we operate is effectively bust. The ever spiralling financial crisis faced by the NHS is surely testament to that. And the worst of winter is not yet upon us.
The report speaks a lot to the subject of population health and the need for a new modus operandi that addresses the changing needs of the population. There is much here that I can subscribe to, particularly as this concerns a population health approach. It occurs to me that the argument that population health is the responsibility of all health and social care organisations is unarguable.
But I wonder when we talk of the changing needs of the population if the key players have true insight into current — let alone future — needs? Do they have a full understanding of the existing ‘state of being’?
Can the new collaborators answer these fundamental questions:
- What are the health needs of the population as a whole?
- What is the prevalence of certain diseases?
- How is this prevalence distributed?
- Do we understand the full scale of multi-morbidity across our population?
- Are services in the right places?
And when we talk about a collaborative and co-ordinated approach to the management of resources — and I’m a believer — can the principle players answer these key questions:
- At a whole population level, how are healthcare resources currently delivered and consumed?
- Can we quantify this?
- Is resource allocation morbidity-adjusted?
- Is the allocation of resources fair and equitable?
- Are finances targeted to those most at need?
If we can’t provide answers to these questions then we need to… and quickly.
It occurs to me that the starting point of any future strategy based on population health management is insight as to the current ‘state of being’ of that population; this allied to a precise understanding of how scarce resources are currently deployed and consumed.
We must recognise that an approach focused on single disease groups is flawed and that a populations’ needs are multiple. Co-morbidity is the norm.
To-date analytics in support of population health strategies has been principally the preserve of public health and commissioners. Even here the track record is patchy, often the result of frustrations borne out of problems accessing the data.
This state of affairs is not acceptable.
If the future is to be truly collaborative, where the existing boundaries between commissioning and provision become increasingly blurred, then population health perspectives and service transformation activities are as much the responsibility of providers as they are of commissioners.
In this context at least, the phrase “We’re all in this together” has some meaning.
Are you looking to implement a population health management strategy?
Read our Five Steps to Population Health Management article.