On the 1st April 2013 something remarkable didn’t happen! The end of the World didn’t happen for the NHS.
Remember the fears? The American corporations were going to sweep over the horizon and take lucrative contracts from the NHS who would lay off vast numbers of staff. Many feared that they would actually have to pay when they saw their doctor, that prescription charges would rocket and that chaos would leave the dead and dying on our streets.
Nothing could be further from the desperate scenario painted by Labour over 2+ years. The rate of movement to the private sector is little different to that which occurred during Labour’s years in office. Yes the clinical commissioning groups are beginning to put more activities out to tender but that is not because they want to change to the private sector but because they used their local knowledge to want to change the nature and the scope of the services being provided.
That is the key to the changes as far as I was concerned. I took some stick for moving two debates on the NHS at the spring and autumn conference in 2011 when the debate was at its height. I was accused of being Nick Clegg’s lackey (though Nick could only dream of such a luxury) and selling out my liberal principles in favour of a market based approach. These what just what Lib Dems called never mind some within the NHS!
I argued four things:
- That the culture of the Health Service needed to change to become a service based on 2012 realities not 1948 practices.
- That we need to put patients needs at the heart of health activity not health service producers
- That localising decision making through CCGs and democratically led Health and Well Being Boards would mean a much better tuning of our services to meet local needs and opportunities rarher than national priorities;
- That hardly anyone would notice the changes because for the lucky 90% of us most of our interactions with the health service are with GPs, Pharmacists, dentists and opticians who are already ‘private sector’
Two things have convinced me that I was right to make those arguments:
We continue to hear of the problems caused by old style NHS culture. Mid Staffs, which is in the papers again today, being the best example. A service which was shaped around an inflated bureaucracy; which was output not outcome oriented and in which there was a failure to join up services within the NHS never mind within the other services such as social care, education and policing with which a health service needs to react.
This latter point is very important. We must never again allow health to the province just of health professionals and an enclosed health community. Every service that the council and other parts of the public sector provide from parks to housing contributes or detracts from good health.
On the positive side I attended a meeting of Liverpool’s Health and Well Being Board yesterday and there I saw everything that I had hoped for beginning to happen. It is rare for me to be energised by meetings down at the ‘Town Hall’ these days but I was delighted at yesterday’s meeting. We had all directorates of the council represented along with 4 councillors. We were joined in the Board by the CCGs, by other representatives of the health service, by patient’s representatives and academics.
We shared agendas that we would never have shared before. First item on the agenda was a report from the Mayor’s education commission, we jointly looked at alcohol and tobacco problems and then the piece de resistance was a major presentation for discussion about how we need to reshape:
1. The way the Health Service and its partners look at health
2. The way that the health service and its partners join services up differently
3. How the council and its partners frame the debate within all agencies but crucially with the people of Liverpool about how health services should be provided and the roles of the public, private and third sectors as well as communities and families in developing a proper debate on health needs and provisions in 2013.
This is not a completed task but it is a very strong first step forward. We recognise that in all these things we are on a new path of integration and joined up service delivery. The end result was not there but the spirit and thinking to create that end result most certainly was.
Liverpool’s Health and Wellbeing Board was just a place where new ideas could flourish, new methods take over and better outcomes could be conceived. I know that there are still problems with the Health Service that these discussions will not be able to cure in the short term. I am convinced however that this new approach is working and that we will see improved outcomes for our residents. Nowhere needs this more than Liverpool where we have appalling health outcomes for our citizens. But I doubt if anywhere is getting ahead of Liverpool in creating the change necessary to deal with those dreadful outcomes.