NHS long term plan: three new models of care that could be replicated across EnglandBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l254 (Published 21 January 2019) Cite this as: BMJ 2019;364:l254
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The NHS has centred on three big truths. There’s been pride in the health service's enduring success, and in the shared social commitment it represents. There has been concern regarding the funding, staffing, increasing inequalities and pressures from a growing and ageing population. Also possibilities for continuing medical advance and better outcomes of care.
One of the flagship pledges was to create he integrated care systems in every area of England by 2021. Local government and organisations working in a more pragmatic and practical manner is essential. The plan is already successful and has a few schemes to be spread across the country.
1. It guarantees support to people living in care homes and has improved services and outcomes for people living in care homes and those who require support to live independently in the community. The aim was to improve the quality of care to residents especially those at the end of life and increase residents' involvement in decisions about care.
2. An integrated tertiary service providing psychiatric care for patients with persistent physical symptoms is also introduced. People with complex mixed medical and psychiatric illnesses are taken care of, thereby improving the patient care that “really suffers” and is “really misunderstood “.
3. The scarred liver project is another new diagnostic pathway to deliver chronic liver diseases at a much earlier stage where patients can be referred for non invasive transient elastography to detect any scarring and later can be referred to secondary care. This project tried to predict liver cirrhosis more effectively and improved outcome for patients with liver diseases – alcoholic or non alcoholic.
However, in the Indian context, various attributes work towards healthcare. Rapidly increasing disposable income, growing urbanisation and higher levels of literacy are known to have a significant impact in contributing to higher healthcare spending. The vast majority of Indians, particularly in urban India, are experiencing a transformation in service sector such as banking, entertainment, telecoms, education and aviation, which is comparable to anywhere else in the world. Such exposure results in a more demanding and discerning consumer. Increasing penetration of health insurance, both private and government-funded, helps in improving the overall affordability, and hence spend and the ability to choose.
Every state holds the responsibility for “raising the level of nutrition and the standard of living of its people and the improvement of public health" among its primary duties. The National Health Policy endorsed in 1983 and updated in 2017 mentions the need to focus on the growing burden of non-communicable diseases, emergence of robust healthcare industry, growing incidences of catastrophic expenditure due to the healthcare costs and on rising economic growth enabling enhanced fiscal capacity. Government health policy has thus far largely encouraged private sector expansion with well-designed public health programme. AYUSHMAN BHARAT - one of the biggest government funded healthcare insurance was launched in the year 2018. The government unveiled plans for a nationwide universal healthcare system, considering the goal of Universal health care as part of the sustainable development goals known as the National Health Assurance Mission, which would provide the citizens with free drugs, diagnostic treatments, and insurance for serious ailments.
The national urban health mission focuses on expanding healthcare to the urban poor while the Pradhan Mantri Jan Arogya Yojana (PM-JE) is a leading initiative of Prime Minister Modi to ensure health coverage for poor and weaker populations in India. This initiative is part of the government's view to ensure that its citizens - particularly poor and weaker groups - have access to healthcare and good quality hospital services without facing financial difficulty.
One initiative adapted by governments of many states in India to improve access to healthcare entails a combination of public and private sectors. Rashtriya Swasthya Bima Yojana which reimburses those under the poverty line; and National Rural Telemedicine Network which assists with non-medical costs.
Finally, the National Rural Telemedicine Network connects many healthcare institutions together so that doctors and physicians can provide their input into diagnosis and consultations, thereby reducing the non-medical cost of transportation.
There is a great need to create functional progressive referral systems as is found in countries like the UK, where the bulk of healthcare is managed at the 'front' or at primary healthcare level. There is a great need to focus on preventive aspects in healthcare. In view of the likely impact on costs of lifestyle diseases so prevalent amongst the masses in India, as a country we can't even afford treatment. As they say, if the disease doesn't kill you, the treatment will. It is extremely unfortunate that even the government does not seem successful to care enough about this aspect.
Competing interests: No competing interests
These are terrific examples of the work in Nottinghamshire. There are other examples in south Notts and indeed Mid Notts. But there are two unanswered issues that are not addressed in this article:
First, the success that they have had has been years in the making and has taken tremendous resolve and leadership by people like Stephen Shortt and Hugh Porter. They, and fellow GPs have been working at building relationships and trust for many years. They are hard working and dedicated leaders - the question is not how do we change put in place better models of care that we’ve known about for years, but how do we develop enough leaders to make it happen?
Second, it isn’t clear if the resources released were reinvested or went into some anonymous savings pot. It is becoming increasingly clear from looking at international case studies and from work of economists like Ostrom, that if the money can be reinvested (or at least partially) then the motivation to change complex systems of care is greater. Conservative estimates suggest 10% of NHS resources are locked in lower value care, completely untouched by productivity or efficiency programmes like GIRFT. The investments that Shortt described are hard to access, often linked to highly bureaucratic processes. That has to change.
Competing interests: I work for a small social enterprise that receives fund by providing advice and training to healthcare systems to help them improve population and personal value