Guest Blog by Simon Bottery, Director of Policy and External Relations, Independent Age
Older people, as we know, are huge users of the NHS. People aged 65 or over account for one in six of the population but one in two
hospital bed days and 60 per cent of the one billion medical items prescribed every year. So as an older people’s charity, Independent Age has been looking hard at how we can best help people navigate the complexities of the NHS. It was that spirit of enquiry that took me to last month’s NHS Confederation conference in Liverpool. The Confederation is made up of the organisations that plan, commission and provide NHS services and I was keen to see how we could best engage with them.
I’m not sure I’m much better informed on that question but I did find the conference fascinating, not least for the evident differences between the NHS sector and that group of services with which it is so frequently urged to integrate – social care. What follows is a series of first impressions, some of them perhaps poorly-evidenced, under-considered, naïve or just plain wrong. But maybe some of them will strike a chord.
- It felt as though there were a lot more planners and perhaps commissioners at the conference than there were providers. Within the first 24 hours, I felt I was drowning under a weight of organisational acronyms and system charts. A typical breakout session would have a title like ‘Challenges in transforming care collaboration: new models of innovation’ and would feature two or three earnest professionals worrying about their organisations structure and culture. You may think I’m exaggerating but the full list of sessions is here http://bit.ly/1B2M6CQ : have a look. One cause – or possibly effect – of that focus on planning and commissioning was a relative lack of examples of actual service delivery. There were a few, often impressive, contributions from GPs in particular, outlining how their practices worked within their communities but I would have loved to have heard more, about and from a much wider range of services. It was ironic that perhaps the most powerful plenary presentation came from Brigadier Kevin Beaton OBE of the Military Medical Service who spoke, with Lt Col Maggie Durrant, about experiences in Iraq, Afghanistan and Ebola. But the strength of this presentation was at least in part because it was so atypical to normal NHS service delivery (which drew the wry observation from Brigadier Beaton that the Ebola clinic was one service that CQC had decided it did not need to inspect directly).
- Probably as a consequence of the lack of service providers, it was quite hard to find the patients’ perspective. In fact as delegates were making their way home, the local Liverpool Echo was running a story about a pensioner ‘trapped’ in his flat because of a faulty lift, and the effect on his health and wellbeing. I thought ruefully that this seemed one of relatively few occasions on which service users – ‘patients’ – came into clearly into view during the conference. For the rest, end users were largely represented as statistics and data. That felt very different from a typical social care event, where the involvement of service users and often the inclusion of them in service planning (‘co-production) is becoming more mainstreamed. Perhaps tellingly, the only time I heard the term ‘co-production’ used was when NHS Confederation Chief Executive used it to describe how the NHS Five Year Forward View was put together – but he meant that it was co-produced by the six umbrella bodies in the NHS Confederation – rather than with service users.
- Ah, that plenary session with the six umbrella bodies. It seemed to this outsider to be a fairly uncontroversial idea – putting the chief executives of the CQC, Monitor, NHS England, Public Health England, Health Education England and the NHS Trust Development Authority – on stage together. But what they ended up saying was unfortunately rather less memorable than the immediate visual impression they created: the lack of diversity in six white, middle-aged men. After an initial attempt to humour through it by imagining the group as the ‘world’s most unlikely boy band’, chair Anita Anand admitted: “It’s rather white and ‘suity’ up here, isn’t it?” Would it be any better if we put together the leaders of umbrella bodies in social care or the voluntary sector? At least a little, I’d like to think. Diversity was more evident in other sessions but even then it gave pause for thought. Surely no speaker at a social care or voluntary sector conference – even a total outsider – would begin his speech by saying ‘What a pleasure it is to be on stage with four lovely ladies’. But that’s exactly what one senior manager from an IT company said at the start of a ‘Tomorrow’s World’ session on technological change.
- Despite all that talk about integration of health and social care, there wasn’t really that much evidence of its importance at the conference. NHS England chief executive Simon Stevens mentioned the ‘triple integration’ – primary/secondary, physical/mental and health/#socialcare. Health Secretary Jeremy Hunt spoke about the need to ‘integrate at pace’ health and social care. A session about the radical plans in greater Manchester again touched on integration. But truthfully there was little too in the way of attendance or input from the social care, housing and voluntary sectors. There was at least one session involving a non-profit housing association, Home Group, and Stroke Association were exhibitors but this was far from mainstreamed. I don’t think we can blame the NSH confederation for that though – the opportunity to engage is there.
- Rather than integration of health with social care, what seemed more immediately focusing minds was the reality of linking one part of health to another. The overwhelming impression gained from three days with the NHS confederation was of sheer scale and complexity of the different trusts and member bodies, leading to the almost inescapable question as to whether, in reality, there is any such thing as the NHS. Psychologists talk about our tendency towards ‘reification’ – to regard or treat an abstraction as if it had concrete or material existence. The NHS felt an abstraction rather than a single body in any meaningful way. Attempts to create that sense of unity didn’t always succeed totally. NHS Confederation chief executive Rob Webster got a round of applause for his assertion that ‘what gets us out of bed in the morning is the same, whether you’re a porter or a chief executive’. Sharing that on Twitter, drew one response: ‘Bollocks. What chief executive has to worry about whether he can afford to eat next week?’. It’s a fair point, isn’t it?
- But for all the confusion and fog, I did genuinely take away a lot from confed. I gained even greater respect for the clinicians who work in the NHS and – genuinely – for the managers and commissioners who have to make sense of its complexities. I met lots of people including many from organisations who I can imagine working with in future. Above all, I learnt a huge amount about the NHS, not least the realisation that I had known very little to begin with and that a very steep learning curve lies ahead. I also picked up quite a few aphorisms to be dropped into conversation (my favourite, delivered by Dr Paul Grundy, who was an architect of the Obamacare reforms, is: ‘If you want to herd cats, you’re going to have to move the food’.) Finally, I must say that Confed did live up to its billing as a tremendous source of freebies from the many organisations that exhibit. Pedometers, fans, data sticks – you name it, it was probably on offer somewhere. Free rucksack, anyone?
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