COMMENT
“This has got to be something where em- ployers build trust with other stakeholders in the system. The professional bodies and the royal colleges have a real stake in the outcome for professions. Employers have to drive this.”
Information
However, Slipman acknowledged that there were some ‘challenging’ things in the report, and a lot of risk related to the changes it proposes. She explained: “Per- haps the most challenging recommenda- tion is around information owned by pa- tients, which has to be right in principle but it is actually a very radical idea.”
The forum wants patients to have clear ownership of their data, and the report makes clear that data sharing is vital for safety, quality and integrated care. This data can then drive further quality im- provements and lead to greater transpar- ency of process.
Slipman continued: “What determines in- formation in the system right now is the regulators’ demands. That’s a much more significant determination factor for the way in which information is produced, and that demand will continue in the future. The report is silent on how we’re going to make this transition to patients owning the information. How is regulation going to help and support that to happen? Rather than demanding a parallel and different set of information for regulated purposes.
“In the end it will be the regulators that drive that, rather than goodwill. The report doesn’t have any recommendations about how that should happen. That seems to be the next stage in achieving that objective, to have a look at exactly how the regula- tors are going to change their information needs to make that happen.”
Integration
Considering the report’s stance on integra- tion, Slipman said: “That is really positive. It is in patients’ interest to close hospital services where organisations are inefficient and are not viable in favour of supporting others to respond to those complex patient needs, for those who require care both in hospital and in community settings. Inte- grating those care pathways is clearly im- portant and significant.”
However, she warned that this will only happen if a change in the pattern of the way services are delivered can occur – “The problem we have had to date is there hasn’t been the political will to enable those
changes to be made,” she said.
The report’s recommendations on this top- ic include integration around the patient and not the system, as well as making it easier for patients and carers to coordinate and navigate around the health service. The forum suggests that information is a key enabler of integration and by measur- ing patient feedback, this will allow the NHS to improve its performance.
Additionally, flexibility is necessary for providers to work together, especially with health and wellbeing boards, as well as in the sharing of best practice and for break- ing down barriers.
But Slipman said: “Demand isn’t being taken out of the acute and secondary sec- tor by judicious investment throughout the whole healthcare system, and it’s not being done in a way that enables the secondary sector to change their offer and remain a sustainable organisation. There’s a huge amount of risk out there in the system that isn’t being properly managed to help those changes occur. We did a survey some time ago that showed this was about readmis- sion. Even in avoiding readmission into
hospital, 50% of commissioners had had no discussions with their providers about where the investment should go and how that could best be achieved.
“If we’re not even at that level of sophisti- cation in the system then I’m not sure how we’ll achieve all of this.”
She suggested that more transparency was necessary to show where investment goes, in order to make judgements about wheth- er it’s working to take demand out of the secondary system.
“It’s the worst place we could be, for that money not to be invested properly and not taking demand out of the secondary system, but then punishing the secondary system because they’ve got levels of activity above demand. There’s real risk around the delivery of some of these things and it has to be done with care,” Slipman added.
Public health
The report also suggests that healthcare professionals should make every contact count, and all NHS staff should take the opportunity to discuss public health is- sues concerning diet, exercise, alcohol and smoking (see case study, left).
The NHS should be refocused towards pre- vention of disease and the promotion of healthy lifestyles in a more holistic sense, the Future Forum recommended. This in- cludes improving the health and wellbeing of the NHS workforce and building part- nerships outside the NHS to share learning and best practice.
CASE STUDY
NHS Salford is already acting on the recommenda- tion to make every contact count, by working with Salford City Council to provide training for staff to raise discussions with patients at every opportunity.
Melanie Sirotkin, director of public health for the PCT and city council, said: “We are expanding on the ini- tial principles by involving a wider range of staff and by training staff to be able to discuss a wider range of issues that affect health and well being such as life- style choices, money, employment and housing. Our aim is for people to be more informed when making decisions that could impact on their lives.”
Cllr John Warmisham, lead member for adult social care and health at Salford City Council, added: “This process is about making sure anyone who has con- tact with the public is in a position to offer them ad- vise on any health issues and put them in contact with the right organisation to get help. Health and wellbeing affects every area of a person’s life.”
Slipman commented: “I think it’s right that we use the contacts in order to spread mes- sages but the rest of the world is moving to a nudge culture rather than a bludgeoning culture about these issues. You’ve got to get the balance right in terms of who has the responsibility.
“Certainly you need cooperation around getting the messages out there, using all the agencies who can work together to do that. Clearly health has a big responsibility in the preventative and behaviour agendas but it’s not only a responsibil- ity about health mes- sages, it’s also about understanding people’s health in a more holis- tic way. And that brings you back to the integra- tion agenda.”
Sue Slipman
FOR MORE INFORMATION The report is at
tinyurl.com/future-forum-2
national health executive Jan/Feb 12 | 19
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