2023 Resolutions

Resolutions

It is a time of year when people determine what they want to do for the best for the coming year. It is a time when the challenges to people’s health and health care have never felt so overwhelming. It is a time when we are probably only two years (at most) away from an election and politicians are beginning to set out their stalls.

Predicting what will happen in 2023 feels very difficult. Back in 2008 I was part of a team, in the East Midlands, that developed four plausible scenarios for the future of health and care. One was that the government would plough money into the health service. We named this scenario ‘Fool’s Gold’. The second was that the Wanless recommendations for public health would be adopted and the NHS and social care would work in a collaborative and integrated way. We called this ‘Red Arrows’ after the RAF’s synchronised flying team. The third scenario was called ‘Swimming Upstream’, where society ignored Wanless, but the NHS and social care got their act together.?Our final scenario was a ‘Tale of Two Citizens’, where those who could afford to abandoned using the NHS.

I learned a lot from doing this work. I learned to discern signals that would help me see which scenario was panning out. I also learned to think what could or would change the likelihood of a scenario becoming reality.

Ideally, I would like to see ‘Red Arrows’. I see us, at best, ‘Swimming Upstream’ and at worst opening a ‘Tale of Two Citizens’.

What could change that? In 2023 I would want those with influence to engage with politicians of all persuasions to help them understand what levers they can use to enable the policies needed for 21st century health and care. I see data coming from our work on demand in primary care and see doctors working nine and a half hours a day with 85% of their time focussed on direct clinical care. ?I see people ending up in expensive care not because of either COPD, or IHD or DM but because they have COPD and IHD and DM and social and psychological problems that need to be addressed holistically. I am reminded, by the data, why I chose to try and make the system better for the professionals who go into work every day wanting to do their best for the people they serve yet are defeated by the current system and models of care.

I want politicians and professionals to be able to see and promote the value of Primary Care, which embraces General Practice, Community, Mental Health and Social Services as well as the voluntary sector. In our Population Health Management Development Programme, time and time again, we created new perspectives for professionals and managers using linked data which revealed where the challenges faced by communities, families and individuals were. Once you look at what is happening to people through their eyes, and not by organisation or condition, it becomes obvious that we have assets and strengths to address their complexity and risk but only if we change our assumptions and behaviours across the continuum of care.?

I would like to predict that in 2023 politicians and policy makers value those assets and strengths and think about what really needs to change to harness that potential. Ultimately this must mean the way money is used to support, incentivise, and reward the right behaviours has to change. Payment for activity must be replaced by payment for value. This is not easy and cannot be done in one or even two years, but we must resolve to getting measurement and our money used in the right way to start the change that is so desperately needed.

#NHS #Populationhealthmanagement #incentives #populationhealthanalytics