Ideas for obtaining the best value for money in the NHS

This is a note my father shared with me just before the pandemic, but it may be useful to a new government in a couple of weeks! Two points in it particularly appeal to me:

• "Consider holding an open, public debate on health care rationing." When will a government properly engage the electorate and bring the discussion of difficult issues out in the open?
• My father' "five Cs of safe, high quality health care: Competence, Compassion, Communication, Continuity and an effective, understandable Complaints process." In marketing, we have "Ps", but my father's last one is so important and something about accountability (maybe performance for marketing) should be added to all of these types of lists.

from work in the House of Commons and on the Health Select Committee 2001-10.

Persuade clinical staff always to use / prescribe evidence-based treatments.

Integrate primary care (by GPs) and hospital care by getting GPs and hospital doctors to work together much better.

For this to be fully possible the market in health care, in other words, the purchaser/provider split, would have to be abolished. The purchasers are the GPs via their Clinical Commissioning Groups (CCGs) and the providers are hospitals through the NHS Trusts.

The market in health care costs an incredible ￡14 billion per year for extra administrative staff. (Health Committee figure from 2010.) Abolition of the market could only be considered if the NHS was taken out of political control as the market is a Tory brain-child and their ideological necessity.

Improve patient education to encourage self-care and reduce demands on health professionals for some long-term illnesses and minor complaints. An example is the @DAFNE ‘DAFNE’ project in diabetes care (‘dose adjustment for normal eating’). This helps adults to manage their own type-one diabetes with less professional follow-up.

Resurrect the productive ward initiative, an idea of a previous Labour government where hospital staff were encouraged to discuss all their activities to work out the best and most efficient way of delivering all aspects of the care they provided.

Another valuable process started by the previous Labour government was to study different hospitals’ methods of treating the same illnesses to discover ‘Better Care Better Value Indicators’ for all to follow.

Improve the prevention of obesity, smoking and alcohol abuse.

Consider holding an open, public debate on health care rationing.

Consider the feasibility of paying off early the huge debt, building up for the next thirty years, from the building of hospitals under the private finance initiative (PFI).

AS AN AFTER THOUGHT: my five Cs of safe, high quality health care:

Competence, Compassion, Communication, Continuity and an effective, understandable Complaints process.

Posted two days after my father passed away. RIP Dr Taylor 7.7.1934-26.6.2024.