EFFICIENCY
Gatekeeper
A central financial model for the NHS is that the money follows the patient, yet this does not fit with the disruptive nature of cCBT. The usual financial arrangement for cCBT in the NHS is that, presuming a PCT has bought the service, a patient can be re- ferred to cCBT by their GP. As money fol- lows the patient and clinical activity, each patient’s use of cCBT has to be tracked and, if only on a small scale, a funding decision stands before a patient gets access. But this works against some of the benefits of cCBT. It loses the value of cCBT in reach- ing a large population if a gatekeeper is put in the way. Instead of avoiding the stigma around mental health issues, we put the barrier back into the system.
Imagine an alternate approach. Imagine if the NHS centrally offered cCBT online to all-comers. Usage would be hugely in- creased. cCBT would be able to reach a wider population unwilling to go first to a healthcare professional. Because the mar- ginal costs of cCBT are low, the total cost to the NHS of making cCBT more widely available would be comparatively small. This isn’t just a pipe dream. It is close to the approach taken by the Dutch govern- ment to e-mental health services. But back
in the UK, central NHS Web services have long been under-resourced.
We have specific interests in cCBT, but this article is not intended as an argument spe- cifically for cCBT. Rather, the point is that novel information and communication technologies do not necessarily fit existing structures and their benefits will be lost if this is not recognised.
Outside of healthcare, we have seen com- mercial sectors invent new business mod- els in response to ICT innovation. So, Ama- zon makes money in a very different way to a high-street bookshop. Such changes were not straightforward: it has been a painful transition with many high-street book- shops closing. But although healthcare has some catching up to do, we can at least learn from these experiences.
Behind the times
These days, although uptake remains low, cCBT is an established approach. The new focus in research is on m-health, the use of mobile phones and related devices in healthcare. We can envisage mCBT, deliv- ering CBT over a mobile phone, soon ap- pearing alongside the many other m-health systems for which we have an evidence
base: appointment reminders, smoking cessation, improving medication adher- ence, supporting self-management of long- term conditions, m-learning etc.
In the commercial world, the mobile sector has developed rapidly. New services have appeared, and alongside them, new busi- ness models. This world, of SMS re-sellers and short codes, is still alien to healthcare managers and clinicians. If m-health is to advance quicker than e-health, we need healthcare services that understand mo- bile and that are flexible enough to cope with new ways of working. The NHS needs to be able to develop and share expertise and infrastructure in m-health. Instead, disease specific silos, fragmented budgets and inexperienced commissioning groups threaten to keep technology adoption at a snail’s pace.
Dr Henry Potts
Amy McKeown
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
national health executive Sep/Oct 11 | 33
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104