The ACO can gain extra money through sharing savings (with Medicare) resulting from collaborative efforts to provide care cost-effectively. Stringent governance conditions must be met, along with transparency and quality performance – Medicare ACOs will report on 33 different quality metrics.
NICE would have to be strengthened further- empowered patients. GPs would have to be part of teams of OTs, Physios, social workers- integrated care teams. Their training would have to be longer and we’d need more GPs Specialist numbers would have to be reduced and centralisation would need to occur. heart units would need to close. fewer beds and further away. quality would be higher, junior doctor training would have to be even more broad based then it is. the nature of academic medicine would also need to change and be much more focussed on delivering clinically relevant data- possibly leaving universities to concentrate on the pure science and CLAHRC like organisations to lead on implementing research into practice. outcome measures would have to be rewritten- disease specific replaced by whole care outcomes. preventative healthcare- shot in the arm..but again its making sure that the minority who are most vulnerable are not left out- NICE pathways strengthened so that entitlement is really clear. LHWBs will have a huge task. I’d do away with CCGs, clinical senates and and invite them to join the board. where would choice fit in this agenda? Paul corrigan- Problems- politics- local elections- conservative councils- they could open up the field to private providers so long as the nice entitlements are met- the charge is that this would lead to fragmentation.... If care is whole person care however, it wouldn't matter who provided the care. Reorganisation- it will need reorg.
• Recent developments in healthcare
Politics (lessons from Obamacare)
• Power & its structures
• Persuasion: Individual (health
professional) & College
highest satisfaction rating
lowest waiting times
and finance before patients
‘no top down reorg’
urge to tinker
extension of NL policy?
health & social care act
its the economy, stupid
social care cuts
Labour- health policy review
patient satisfaction fallen
Access: a&e waits
mental health access
Section 75: A week is a long time in politics...
H& SCact- primary
Briefing – The National Health Service
(Procurement, Patient Choice and Competition)
Regulations 2013 01.03.13
The proposed regulations make fragmentation of care more likely.
Compulsory tendering could lead to deskilling
within services and potentially reduce their
quality and effectiveness.
Compulsory tendering could lead to a deskilling in
mental health, for example by other professionals
being employed to lead services instead of consultant
psychiatrists in order to reduce costs, despite evidence
that consultant-led care justifies its extra cost in terms
of benefit to patients.2
The Regulations contradict assurances given
by the Government about competition
during the passage of the Health and Social
Care Act 2012.
Under the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000
Medicare beneficiaries for at least three years.
ACO creates health plan
Financial reward if ACO keeps
enrolled out of hospital
"If we look to the US the best providers are working on that highly integrated
basis, co-ordinating physical, mental and social care from home tohospital.
We need to take what's best and universalise it here." kings fund speech Jan
care would move out
of hospitals, but
probably still led by
there would be a
new role for DGHs
risks & challenges:
social care- all the money goes there
nothing comes to mental health
structural reorganisation (not again)
general practice status
training issues;- consultants go?,pay??
skill set of Local Authorities?
Local authority diversity
NHS in its current format can’t continue
option 1-competition, more players
option 2-efficient, preventative
Qn. A recent Schizophrenia Commission report highlighted
catastrophic failings in the care of people with severe mental
illness. We know that suicide rates rise during times of
economic hardship and that record numbers of people are being
detained under the Mental Health Act. The Government have
said that mental health should have parity with physical health,
so why has funding for mental health services been cut for the
first time in a decade? (lillian greenwood, Nottingham South
(Lab), 27 Nov 2012)
attendance at the party political conferences
written evidence to select committees
briefing for individual MPs
lobbying on amendments eg, parity of esteem
projecting ‘soft power’ e.g, Ed M’s speech
Tory MPs essays on mental health
adjournment debates- ED, Scz., mental health
mental health discrimination act
(by the way, we are recruiting ;))