Health care is broken and broke. The latter is a recent realisation while the former is our dirty little secret. And we have known it for some time. Our self-interest and secrecy has served us well, but health care poorly. The state of the national finances is now shining a light on the profession, and our leaders are being found wanting. It’s time for new leaders that understand the new world.In the new world citizens want to know what’s going on. Years of research into the biological and social determinants of health have hit their radars. They realise that sickness happens and a significant proportion of them want to avoid it. If they fail in that, they want to get better – and quickly. And they don’t want a nosocomial along the way.
England’s new world is also one of recession. While recent reports suggest we’re climbing out – albeit stained by the failure of “light touch” regulation in the banking sector – it would be a mistake to believe health care financing will ever return to its opulent past. Year on year increases in spending have little to show except for shiny new clinical toys, often poorly tested and equivocal in performance.
Combine the desire to know what’s going on with concerns about spending and you get a citizenry that wants value for money. They don’t want to know that you did something; they want to know that it worked. And they want to define what “worked” means.
All this is going to need a new kind of data collection – outcomes, not activity, based. The current activity-based data is pathetic at analysing clinical effectiveness – not surprising given that it was designed for payment not clinical purposes. Clever people are working on an outcomes framework that will help bring transparency, building on the excellent work by NICE over the years. But it’s taken too long to get here.
Citizens have had enough. They’re creating apps that track every measurable part of them. They’re collating the data to make it mean something. And they’re making decisions based on it. They don’t need you until it goes wrong. And then they want guidance, not patriarchy. They want understanding, not orders. You’re a knowledge partner, not the boss.
This future is here. As always, it’s not evenly distributed. Those of you practicing in green belts will recognise aspects of it. One or two of you practicing near so-called Silicon Roundabout in East London are living it. It is with an understanding of this future that we need to redesign services. Not for the medical profession, but for its customers. It’s their money we’re spending, after all.
The future is about transparency. It’s about doing what we know works, while being honest about where we’re taking punts. It’s about open access to better clinical performance data. It’s about accepting different types of analyses – those of the profession, those of the government, those of citizens, and those of industry. It’s about consensus-based decision-making, whether at the national or individual level, and every level in between.
Service design is not just about bed numbers and pathways it’s about embracing this whole new future. The Atlas of Variation has shown us that we have singularly failed to deliver health care that we know works – our dirty little secret is out. Questions are already being asked of our “self-regulation”. We need new leaders to guide us into these fundamental changes in health care and help design the services of tomorrow.
Competing interests: I advise Sir Muir Gray, an author of one of the articles cited and the Co-Lead of QIPP Right Care, the group behind the Atlas of Variation.
The British Medical Association commissioned this post as part of their reconfiguration blog, which no longer appears to be online.
