Fragmentation: the NHS Bill offers the opposite

Yesterday I highlighted some of the claims that this Health Bill will cause fragmentation of the NHS. The irony is that it actually offers the opposite if clinicians show the necessary leadership: a chance for a more holistic approach for the care of health conditions; a more complete and consistent approach between neighbouring GPs; and the coming together of experts to offer centres of specialised excellence. For instance:

  • GPs in their consortia will finally have the authority to encourage and steward their colleagues through peer review, raising standards, asking for accountability from the outliers. The variation of care in some areas has been shocking.
  • More mature relationships between community and acute sector staff will be encouraged through the development of integrated pathways and creating a package of care around the whole patient rather than individual treatments. A joined-up approach is essential if we are going to achieve truly patient-centred care.
  • There will finally be an impetus for specialists to band together in NHS Trusts where they can treat the volume of patients necessary to ensure that the treatment delivered is as safe as possible.

The latter is a major challenge to doctors and politicians alike. It will mean small units undertaking few operations will close and both clinicians and the local MP will have to communicate the truth that whilst there is much that local, community care can deliver, you really should be seen by an experienced surgeon for your operation. Value in healthcare has to be about patient outcomes and Dr Phil Hammond’s 20 year campaign to shut small units is based on evidence. Children died in Bristol and Oxford because their heart surgery was undertaken by inexperienced doctors. Your mother is much more likely to have a poor outcome if her hip is replaced by someone who only does one a week. What’s more important – having a local hospital or being able to walk after your operation? Chances of success need to trump the lure of convenience.

Smart hospitals are already delivering community care and they should badge their cars, bags and staff with the brand of the Hospital Trust. One of the cultural changes we need is the way we perceive hospital care: it needs to change to it usually coming to us rather than us going to them. After all, ‘hospital’ comes from the Latin “hospes” which refers to either a visitor or the host who receives the visitor. It’s about the service, not the building.

About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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