I am always amazed when I read new year predictions of the so-called ‘experts’ in the City as to where the FTSE will be at the end of the year. They vary so dramatically. It means that most of them will be wrong, some of them wildly wrong. It is the same with estate agents and their predictions of house prices.
Then I look back at the blog of my own predictions for the NHS, made this time last year. While I might have got some things right I was clearly some way off the mark in suggesting that the Francis Report would hit the streets in 2012. So it is with some trepidation that I offer my thoughts for 2013.
Surely, 2013 will at last see publication of this long awaited report? Leaks in last weekend’s Sunday papers make me feel the government is expecting it imminently. No doubt when it does come it will generate huge media and public interest. For a week or so it will be on everyone’s lips. But will it have any lasting impact?
There is the danger that the events it concerns happened such a long time ago now that all those individuals and institutions criticised will be able to say ‘that was then and this is now – we have all moved on and things are so much better already’.
Another danger is that, however nuanced the report itself may be, the media will just look to pin blame, no doubt choosing ‘managers’ as their scapegoats. I hope that once the noise has died down there will be lasting impact. Perhaps a statutory duty of candour will be a result? Perhaps the training and education of clinical staff, especially nurses, will change to re-emphasise the value of caring? Perhaps there will be a more realistic appreciation of what regulators can and can’t do? Perhaps there will be a renewed emphasis placed on patient safety and on giving patients and carers voice in the system?
Clinical Commissioning Groups will go live in April. I said this time last year that it would be anyone’s guess which model of commissioning we would end up with. I believe it still is. Will the CCGs assert themselves and be prepared to take some tough local decisions on priorities or about service reconfiguration? Or will they be born looking over their shoulders to the myriad tiers above them?
My fear is that only a small proportion will have the resource, experience and will to do the former and may find themselves picked off by an increasingly anxious Commissioning Board, mindful that an election will be a mere two years away. Meanwhile, who is going to keep their eye on the quality of out of hospital services, especially primary care? Will there be any desire on the part of the Commissioning Board’s Local Area Teams to bear down on poor GP performance, let alone consider how to transform out of hospital care?
All that said, just as always, I can confidently predict that the rest of the NHS will muddle through. It’s what it does. Some hospitals, be they foundation trusts or not, will experience severe financial difficulties. I predict the ones most likely to do so will be small to medium sized district general hospitals. Even if the numbers remain small in 2013, this will be a trend we will see intensify in later years. However, addressing which pattern of hospital services we want for the country will be the big question that will go unanswered as the government, in England at least, has ensured that there is enough money ‘put by’ to avoid a financial meltdown.
Meanwhile, what will the Health Foundation be up to in 2013?
We will continue to play our role in developing leaders at the forefront of improving healthcare quality, launching further rounds of GenerationQ, improvement science PhD Scholars and clinician scientists.
We will continue to be a major funder of improvement work in the service by launching further rounds of our ‘Shine’ and ‘Closing the Gap’ programmes. We will place emphasis on selecting teams that can demonstrate a track record in successful improvement projects and who can generate publishable results.
The importance of understanding the economic case for improving quality will continue to run through our work – we’ll be commissioning primary research to examine the cost benefit of improving patient safety and person centredness. Economic evaluation will continue to feature in our award programmes. We will also develop our capacity to act as a conduit for the transfer of international evidence and practice in service innovation.
Based on our track record and where we think an independent voice can make a significant contribution, we will advocate for greater focus by the healthcare systems of the UK on patient safety and person-centred care. On safety, our emphasis will building a consensus on how best to measure it. On person-centred care, we want to spread approaches to equipping patients and professionals to work in partnership beyond the innovators we have supported in the past.
Stephen is Chief Executive of the Health Foundation, www.twitter.com/THFstephen