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Politics march2013
- 1. Politics, Power & Persuasion Arun Chopra Consultant Psychiatrist, A42, QMC WPLC, RCPsych.
- 2. • Recent developments in healthcare Politics (lessons from Obamacare) • Power & its structures • Persuasion: Individual (health professional) & College
- 3. highest satisfaction rating lowest waiting times mh funding targets mid-staffs-managers performance and finance before patients clinical involvement competition (howe) ‘no top down reorg’ urge to tinker responsibility (bevan) extension of NL policy? (warner) health & social care act contextual factors its the economy, stupid social care cuts performance recent developments Labour- health policy review patient satisfaction fallen Access: a&e waits CVS gains mental health access inpatient survey suicide rates detained patients section 75
- 4. Section 75: A week is a long time in politics... H& SCact- primary legislation; delegated legislation: Statutory Instrument AMRoC 1000 doctors
- 5. 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.
- 6. 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 2013
- 8. care would move out of hospitals, but probably still led by hospitals Fewer specialists; fewer specialist centres there would be a new role for DGHs
- 9. 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 (but)remaining responsive
- 10. 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) Lobbying
- 11. 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 ;))
- 12. And one last thought...
Editor's Notes
- 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.