●● DR Paul Bowen, GP with McIlvride Medical Practice, Poynton, and executive chair of NHS Eastern Cheshire Clinical Commissioning Group (CCG)
LAST week I touched on integrated care, and plans the CCG has to purchase care differently through the Caring Together programme.
The problem with this approach is that while the NHS in England aspires to build ‘integrated’, joined up care, in each area, there are very few examples where it has been achieved successfully.
Instead, one has to look at other countries to compare their health systems to ours.
While learning from great care elsewhere, we should also bear in mind that, despite lower levels of funding per head of population than some countries, the NHS actually performs well in comparison to many of its international counterparts. However, there are different models of care within many countries which means we are not comparing like with like.
There is massive variation between traditional models of care and more contemporary approaches, and I and local care leaders have studied various approaches to find the best solution to our local issue.
There is no escaping the fact that, our current care system is unaffordable.
By 2018/19, our local care system will have run up a cumulative debt of approximately £140m based on projected levels of funding and with a rapidly growing ageing population. The way we both purchase and deliver care must change.
Some countries have approached this by combining the health and social care providers.
In New Zealand, Sweden and Spain, pockets of innovation have proven that not only does this save money, but also delivers better health outcomes and experience.
Huge variation in health costs and outcomes in the USA can be attributed to very different care models, some of which involve GPs, consultants and all other care staff working for the same organisation.
Even commissioners and providers have been merged in some areas.
And now, in places like Northumberland and Devon, plans are afoot to combine traditionally separate care organisations into accountable, single care systems.
We must make these difficult decisions, and soon. We must prove that this approach works and delivers high quality, sustainable services that are based as locally as possible.