Know your “rights”! – Johnny Marshall

As I walked up my drive it was clear that the recycling and food waste bins I had left out the night before remained full, whilst all those around had been returned to their natural resting place. How could this be? I had kept my side of the bargain, in paying my council tax and putting the bins out, and yet the public service had let me down. I made the intended pit stop style visit to collect my medical bag, even Red Bull would have been proud, and left a vapour trail of instruction for my daughter to call the council and sort it out!

On my return home later that day I was genuinely pleased to find one of the bins had been emptied completely and the other sufficiently so to keep me happy. I thanked my daughter more warmly than I had perhaps initially sought her help! Those of you with students at home over the summer holiday period can probably imagine how that initial conversation had gone!

The whole topic of responsive public services came up at the final NHS CB Authority Future Design Group meeting. Could you ever envisage a day when having waited too long in A+E or unable to secure a GP appointment you could ring a number and have your needs met to your full, or in my case at least sufficient, satisfaction?

As I reflected on this it struck me that the whole bin relationship was slightly more complicated than it initially seemed. Yes, I was paying my taxes to have my bin collected, and yes, it had not been, but there was a mutual accountability to this that was just beginning to surface. In order to benefit from this valuable public service I had to put the right bin out, at the right time, on the right day, in the right place with the right things in it…. By the way, the brown bin for garden waste collection rights come with an additional annual charge above and beyond council tax!

It was only with all those “rights” in place that I gained my full service rights. If I failed on any of those counts then my right to have my bin collected was to be forfeited. If I succeeded I received a very responsive service. So could this work in healthcare? What would be the equivalent “rights” that would secure our access to our rights?

Locally, many people do not to purchase a brown bin for garden waste but choose to manage this long-term problem themselves with a compost bin in the garden, occasional trips to the dump (provided from their council tax), some infrequent shredding and the annual Bonfire night. Which, as the NHS Commissioning Board Authority moves to becoming the NHS Commissioning Board and the Future Design Group becomes the Executive Team Meeting, leads me seamlessly from the NHS Outcomes Framework Domain 1(Preventing people from dying prematurely), which featured in my last blog, to Domain 2 (Enhancing quality of life for people with long-term conditions) – all as natural as day follows night!

Long-term conditions account for the majority of ill health and expenditure in the NHS. For these conditions, there is no cure. Prevention needs to occur at so many levels; we cannot afford not to do it. Most people with a long term condition have more than one, the number increases with age, and yet many of our services to date have focused on a single disease approach rather than a whole person approach. The solution is not simply a one-off service change to shift care from hospitals to the community but a life-long commitment in changing behaviours to support ourselves and others in staying well. This is not new; you have probably heard it all before. So what needs to be different this time?

Somehow, we need to connect the individual reality with the various threads of the strategy; more self-management, interoperability in electronic records, defined outcome standards, sharing of information, aligned incentives etc. The key to this probably lies in the notion that effective care for people with long-term conditions is predicated on productive interactions between empowered, informed patients, carers and their families, and prepared, pro-active practice teams. The Chronic Care Model captures this moment as the very centre of healthcare through which every other thread of strategy and design needs to make a positive difference. Indeed, unless they make a difference at this point it is unlikely that they will make a positive difference at all. Each intervention required to support these “productive interactions” has to be focused on this one point if it is to have the highest levels of leverage necessary to result in the best possible value. Perhaps then we can get it right?

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