Chris Ham: momentum needed in reform
Professor Chris Ham, Chief Executive at The King’s Fund, shares his view on the challenges facing the Health Service and the need to maintain momentum in reform.
In Northern Ireland – as in many other countries – health and social care continues to absorb an ever higher proportion of public spending, with over 40 per cent of the Northern Ireland Executive’s entire block grant devoted to health and social care.
Given that any present-day narrative about the Health Service cannot fail to reference ‘cuts’ and ‘efficiency savings’, many people would be forgiven for thinking that health spending had actually reduced. This is not the case. But while the health and social care budget remains protected, it is under intense pressure to do more. There is therefore a need for an open debate on the way money is spent and this in turn means the need for a clear direction.
Although meeting efficiency targets and improving quality of care are ongoing and pressing concerns, this cannot distract from addressing the longer term demands of an ageing population, the burden of chronic disease and rising patient expectations. Healthcare systems throughout the developed world face similar problems and there is growing international understanding that responding to these issues demands radical thinking and a bold approach to how health and social care is delivered.
The case for change is not therefore unique to Northern Ireland. The need to plan for the future is urgent and tough choices must be made as to how we invest in health and social care going forward. Putting in place health and social care services that will remain fit for purpose in ten, twenty and thirty years’ time means having the courage to transform services now. Without a fundamental change to the way the Health Service delivers care, the service will struggle to cope.
The response to the Transforming Your Care consultation demonstrated willingness from politicians and the public alike to initiate debate about the future of health and social care. The simple fact is that if people live longer and suffer from more chronic conditions, the care they require becomes increasingly complex. The traditional healthcare systems whereby hospitals, GPs, pharmacists and other healthcare providers act individually was designed for a very different era with too much focus on institutions and prevention coming a poor second to treatment.
What patients need is for all aspects of their care to fit together and be delivered in the most appropriate place. Transforming Your Care aspires to deliver new models of care to meet changing patient needs and provide services that are high quality, sustainable and provide value for money and better patient outcomes. This includes services closer to people’s homes, less reliance on hospitals and care homes, and a system which is much more joined up.
The task is certainly daunting but it is achievable if all of those with a part to play help to support local health and social care organisations to test and foster new models of care. Professions will need to adapt to new working practices and clinical leadership will be vital. Politicians must also show leadership by continuing to support transformation and ensuring an effective political mandate to implement change.
The public need to be reassured that services can be accessed when they are in need and that the best possible care will be provided within available resources. None of this will be easy but delay in facing up to difficult choices will only make the challenges facing health and social care even harder. Health and social care leaders must ensure that the changes made bring about improvements in care and that the needs of patients and users are kept at the forefront as they take forward the work that has now started.
Chris Ham was an independent panel member of the 2011 review of health and social care.
