UPDATE COMMENT


The defining point in the reform agenda


DR CHARLES ALESSI from the NHS Clinical Commissioning Coalition gives his view of the commissioning agenda and why acting the dodo never works


“The new localism agenda allows


CCGs, with our local populations, to deliver better and more relevant care”


T


he relationship between the citizen and state is undergoing a significant change and this is exemplified nowhere more acutely than in healthcare. Relationships between clinicians, patients and


populations, which were once robust and secure, are now becoming more tenuous, and, in some instances, fractured. The trust, which formed part of that relationship, was once never questioned, and the underlying mutual respect is now no longer so evident. A state of malaise has existed for some time.


It would be invidious to point fingers at where the responsibility for this lies, but the very wide availability of immediate information via the internet is a significant factor. It is no surprise there is a disconnect between


what is said about health and how it is perceived. If this disconnect is applied to the difficulties we are having around the reconfiguration of hospitals in England, it is no surprise that the wrong end of the argument receives most air time. But is there anything about the present reforms, which offers more hope than their precursors?


AUTHOR BIO


Alongside his role as a senior member of the NHS Clinical Commissioning Coalition and chair of the NAPC, Dr Charles Alessi is a senior GP partner of the Churchill Practice in Kingston upon Thames.


LOCAL IS THE WAY I believe the new localism agenda allows CCGs, with our local populations, to deliver better and more relevant care. We need to enjoin them in the delivery of health and social care; localism shows the way. Where local relationships are established, conversations about the design and delivery of healthcare have far greater impact with connected and empowered groups of people, who, with their local clinicians, are leading the desired changes. Add to this, the local democratic mandate, which CCGs’ relationships with local authorities will bring, then we can begin to see the strengthening of grassroot relationships supporting the transformation of care locally. Accountability is one of the most discussed areas of health policy internationally; localism shortens the line and enables it to succeed.


A TRUTHFUL NARRATIVE Another essential component to assist in such transformation is a shared and truthful narrative,


which acknowledges the need for prioritisation of available resources within a population defined envelope, rather than the attribution of blame on other sectors of the local care system. We need to move away from the tribalism which exists, and mirrors old class systems. It has no place within the instantly connected working practices of the 21st century.


INDIVIDUAL NEEDS Finally, the last and most important ingredient to success is the population, and the individual. Both need to be genuinely in a position of control of their destiny. They need to own their medical records, not merely gain access to them, to ensure they are the key determinant of the model of care they receive. We are at the latest defining point in


healthcare, with the NHS compared to a living organism; here three species come to mind; humans, who have evolved and adapted to the environment and predation; the dodo, which failed to do so and became extinct; and, the third, which is largely unchanged over thousands of years, and has survived despite predation and environmental change, is the cockroach. It would be a gargantuan tragedy for the NHS to be perceived as a pest, in need of extermination to prevent it becoming a barrier and impediment to change.


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