The Times They are a-Changin’

David Nicholson famously described the Health and Social Care Act of 2012 as “a reorganisation so big that you can see it from outer space.”

As I write, the European Space Agency (ESA) are frantically searching for the ExoMars lander, which rather inconveniently disappeared just one minute before it was due to touch down on Mars. If by some chance ExoMars has managed to survive and should it point its cameras back towards earth, I wonder what it would make of planet NHS?

Whisper it quietly but the biggest NHS reorganisation since the last one is happening before our very eyes. The difference this time is that the great majority of the general public are most likely unaware, not least because everyone involved is very careful not to mention the R word. Unsurprisingly this new world order has unleashed into the NHS stratosphere a host of new shiny acronyms: STPs, MCPs, PACS, LDRs and so on.

Back in the 70s there was a successful British sitcom called Mind Your Language. National bodies, policy makers and health and care leaders on the ground were clearly taking notice because all of the main protagonists are doing just that.

NHS Clinical Commissioners (NHSCC) are a case in point. In a report published last week (20th October), called The Future of Commissioning, they try to answer a question that many of us have been struggling with since the Vanguards were first let out of the traps: what is the future of commissioning and what is the role of CCGs in that future?

The report is an impassioned plea not to throw the baby out with the bath water, and the authors make the very valid point that “CCGs cannot delegate their statutory functions.” That would, of course, require further government legislation and who seriously wants to go through all that again?

The language deployed in the report is telling. The word ‘evolution’ is to the fore, ‘rebalanced’ gets a namecheck as does ‘recalibration’. ‘Collaboration’, of course, is truly the new black.

There are also any number of references to accountable care. Quite a lot actually. Of course NHSCC is not the only national body to be talking a lot about accountable care, it seems these days everyone is at it. As if by magic a discussion of accountable care — and ergo value based commissioning — appears to have moved away from the water cooler and into the mainstream.

While debates for and against accountable care — largely based on the evidence of the US experience — persist, the argument about the need to focus on placed based systems of care and population health seems settled.

Of course all of this talk about population health has got the Big Data boys and girls very excited. Seems like you can’t move these days for big data suppliers telling you how their brand new shiny widgets are the answer to all your population health management woes. These days it seems big is best. For my part I tend to a world view where small is beautiful. I lay no claims for original thought here, E. F. Schumacher1 got there well before me.

The big data / big supplier argument can be very seductive and the NHS is no less immune from its charms than any other industry. However, before leaping straight into bed with that amorous new suitor, STPs should perhaps pause for a moment and consider what is achievable with the not quite so big datasets already available to us.

The start of the accountable care journey starts with an understanding of current health needs of the population, and you don’t need impossibly big data to achieve insight there.

Anyway whatever you do don’t mention the R word. I mentioned it once but I think I got away with it.

1 Small is Beautiful: A Study of Economics as if People Mattered – E F Schumacher (1973)