Macclesfield Express - - MACCLESFIELD PEOPLE -

●● 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.

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