This month our diarist heard the great and the good talk on the need to get a grip on the whole NHS setup, which restores his faith in the process
This month our diarist heard the great and the good talk on the need to get a grip on the whole NHS setup, which restores his faith in the process.
The story so far
Dr Peter Weaving is a GP and locality lead for Cumbria PCT, an area regarded as something of a white paper pioneer for its innovative integrated care plans and ability of commissioning GPs to steer the PCT out of a £50 million overspend. But they are under no illusion about the scale of the challenges ahead for the NHS...
‘When healthcare costs hit $1.8 trillion even Wall Street sat up and paid attention,' says Ben Chu, placidly.
‘That was back in the 90s; it's a lot more now,' he adds.
I've swapped sleepy Carlisle for the big city, Cavendish Square and the King's Fund, to get a transatlantic view of the white paper. With colleagues from Cumbria I've joined PCTs from Cornwall, Devon, London, Northumbria and the Midlands to meet and discuss healthcare developments with Chris Ham and Ben Chu.
Ham needs no introduction. He is now the chief executive of the King's Fund, a charity that seeks to understand how the health system in England can be improved. Ben Chu used to run the hospitals of New York and now looks after 5.5 million Californians through Kaiser Permanente's managed healthcare system.
‘Like you, we're fully capitated – there's no more money once you've spent it. You've got to stop these acute trusts thinking about income generation,' Chu says.
He points out we need to get our bed base down from two to three per 1,000 population to his one per 1,000 but not, he emphasises dryly, then run them at 95% occupancy.
‘Then you can't move anybody, the ER backs up; it's hopeless.' Any of this sound familiar? Had any red alert bed state emails today? Chu expounds the virtues of having a grip on the whole setup – you need a box around all the services, he says.
Before I hear you groan ‘not Kaiser Permanente again', with its answers to all the NHS's problems, I must say that Chu was at pains to point out that when he joined Kaiser it had recently almost failed commercially and its performance was ‘pretty piss-poor'. It is now the top-performing health organisation in the US and I could have listened to Chu all day.
Instead, my colleagues from round the country treat me to a range of projects and developments that restore my faith in the NHS – and the new NHS at that.
We hear about a community diabetes service run as a limited liability company that cut drug costs, reduced admissions with hypos, less patients had amputations and saw better overall blood sugar control. Sounds like one of Chu's services in a box.
We also hear that if you target patients with deteriorating renal function using a predictive model and treat them appropriately, you can keep them off the expensive misery of dialysis – which saves you £40,000 a year per very grateful patient. Why aren't we all doing this?
The real eye-opener for me is Torbay Care Trust – a health and social care trust – whose financial wizards with some very slick software measure an individual's health and social care spend. To my surprise, we spend far more on social care as we age than healthcare.
The additional advantage of being a care trust is no delayed transfers of care, which equate to length of stay four days less on average than non-care trust patients in the same hospital. Now that makes Chu sit up.
A reaffirmation A reaffirmation