Incentives lacking for NHS changes
pharmafile | June 26, 2008 | News story | |Â Â Â
The King's Fund has warned that there remain significant barriers to shifting the balance of healthcare to local settings.
Despite it being government policy to move patient services out of hospitals and into the community, the think tank says implementation is patchy, and the policy requires firmer direction from government.
Its latest paper, Shifting the Balance of Care to Local Settings: The SeeSaw report, also suggests there is confusion about the advantages of pursuing such a policy and the impact it will have on traditional care. The government and NHS have yet to demonstrate the benefits of non-hospital care and need to be less defensive about the issue, it adds. Care commissioners must be more thoughtful and adept in engaging with their public since patients are unlikely to demand such care if they don't understand the rationale for it.
"At the moment it can be difficult for commissioners to shift more care to community settings when the incentives for change are not in place," says King's Fund chief executive Niall Dickson. "But commissioners must get a more sophisticated grasp of the levers they can use to encourage providers to provide care differently."
The report says the key issues preventing faster and more consistent shift of care to community settings and patients' homes are:
* Current incentives in the health service support and reward healthcare providers who maintain the status quo, rather than PCTs who innovate
* The public is sceptical, believing that NHS restructuring is driven solely by financial concerns and not in order to improve patient care
* The way today's healthcare providers are trained could act as a constraint rather than an enabler of more care being delivered locally
* Providers need a higher level of analytical skills to commission multiple pathways of care in community settings
* Greater use of technology to help deliver care in the home is needed
* Health, social care and housing services must develop closer working relationships
The new report was commissioned by the Department of Health and used a simulation exercise led by the King's Fund in partnership with consultancy firm Loop2 to arrive at its conclusions.
Loop2's Sarah Harvey, co-author of the report, says: "There is great potential to offer more care in people's homes. This may well be the most cost effective way of improving outcomes for people needing care. But there is a limit to what exhorting people to 'work in partnership' can do – there is a need for something more deliberate and formal to remove the barriers to integrating these services."
