Despite the very best efforts and dedication from thousands of staff the care services in Blithering are not as good as they should be and without significant changes they will get worse.
Leaders from within the NHS and local authorities have worked together to agree on the key issues facing Blithering and to think about how changes for the better could be made. Many local groups, local organisations and staff have also been able to submit their views and ideas. Now we wish to consult with the wider public on our ideas.
There are many reasons why changes need to be made. The requirements for service are increasing and changing.
- The population of Blithering is increasing but also ageing. People are living far longer with treatment and support and many more can be supported to have an independent life. As a result just of these changes more people will visit their GP, more will call 999 or 111, more outpatient clinics will be needed, more will go to A&E, more will need support to stay safe in their homes, and more care home places will be needed and so on.
- Health and care needs are getting more complicated. With support people can have multiple conditions for long periods but still have a large measure of independence.
- The NHS in Blithering is not meeting the required standards for waiting times that the NHS constitution says people are entitled to expect.
- The social care system is not meeting the non-medical care needs of many people who could benefit – from children not getting assessments for additional help at school to elderly people unable to live in their home unless some adaptations are made. Lack of care home places leaves people in hospital beds unnecessarily.
- Some clinical services for the people of Blithering are failing to meet required national quality standards set by regulators such as the Royal Colleges; usually this is because there is not enough skilled staff.
- The government has told the care system that it must make progress with 9 priority areas for change.
- There are some parts of Blithering that have particular issues around deprivation and these need additional investment in care services.
- People in Blithering have strong views on what aspects of the care system they would like to see improve.
- There are inflationary cost pressures due to increases in staff and other costs. (Cost inflation in the care system, for example for drug costs, is higher than general inflation as well.)
Just setting out this list gives some idea of the scale of the task facing the care system.
We have examined these requirements and calculated that if there are no significant changes in how we organise and deliver care then by 2021 there is an extra cost of £600m per year to meet these demands. Most of this is accounted for by the extra staff required.
We have been told by government and regulators that the total amount of money for care services in Blithering in 2021 will increase by £150m, leaving a gap of £450m.
This gap is the “do – nothing” scenario but of course there is no intention to do nothing.
It is well known in Blithering and from international evidence that the cost of providing good care services rises faster than inflation and growth in the economy. But, there are well known opportunities to try to reduce the rate at which care costs are going to go up.
We have looked at these opportunities. We have ruled out allowing services to deteriorate, waiting times to get longer or quality to decrease, restricting further access to services and inventing new ways of charging. These are our ideas so far:-
- New measures can be introduced that slow down the growth in demand.
- Prevention
Better to stop people becoming ill at all, to look at those at particular risk of illness and support them.
- Early intervention
If a diagnosis can be made early on then outcomes are better.
- Better less costly solutions
Long stays in a hospital are costly. Some therapies are as effective as other more expensive varieties.
- How care is provided can become for efficient (especially applicable to large hospitals).
- Better ways of caring may mean better outcomes or more patients being dealt with by fewer staff. Some aspects of care might be properly be delivered by less highly paid staff.
- Better management of back office services, procurement, management of the land and buildings can bring savings.
- The costs of managing the care system can be reduced.
- Better integration between all the different organisations involved can allow savings. Ending all the absurd financial rules, regulation and oversight would help too.
We have looked at the possibilities for making these savings and estimated what realistically can be done to reduce costs (from what they would otherwise have been) in 2021. We can only make very general estimates as the information we have is very limited. What we do know is that in order to achieve this reduction investment of around £80m will be needed as a one-off cost over the 5/6 years required to make these changes.
Even if we make all these changes in the levels of demand and in what are known as technical efficiencies (productivity gains) then there is still a large “gap”.
If we are to meet our requirements as above then this gap can only be reduced by changing the way services are delivered. By supporting people in their homes (placing less reliance on stays in hospital). By concentrating services in some hospitals whilst downgrading others we can shut wards/blocks/hospitals down. These are described usually as implementing a new model of care and reconfiguring services and there is a great deal of overlap. A third change could be to reconnect the ridiculously fragmented system for urgent and emergency care so those with a problem can rapidly get to the right place when they need to.
These changes will not all be popular as many see any change or reduction of any service as a “cut”; but they will deliver better care and allow the services to meet both the waiting time and quality requirements.
There will be major changes for hundreds of staff also, many requiring to change their roles or to move their place of work. Implementation will take place over 5/6 years.
These are all desirable changes but whether they will actually reduce the costs of providing the system is unknown. Most current evidence suggests little or no savings will be made but there are a number of places where new ways are being tried out.
On all the evidence available to us we cannot meet all the requirements within the amount of funding that is being promised. In fact without additional funding we may not even be able to restore the services to a reasonable level meeting the imposed targets.
If we use the assumptions we have been told to use by the regulator and by the management consultants that we have been required to use we can provide a schedule which looks as if we can close the financial gap. We do not agree with these assumptions and believe some of the suggested changes have major risks and are wholly unrealistic.
So as it stands today we can say that we can give the people of Blithering the services they deserve but only if we get a lot more money. Or we can invent a lot of bogus numbers, do our best and get bailed out with bungs when we fail.
With thanks to @jtweeterson for bringing the problems of Blithering to our attention.