Outcome-based Social and Health Care

You mentioned outcomes should be the focus and you would integrate healthcare and social care. In practice, how would this actually work?

What we’d have to do first is get a system that was absolutely clear it was going to be about outcomes; to construct our outcome measures with service users themselves. They would be responsible for saying what they wanted to achieve, and you would enable providers to respond to that, price it, and cost it. Then you would say to the individual, “You now have money available,” and this is something you buy into or trade off if you think A is more important than B.

It would require radical reform, also within the NHS because I would like to see some of that NHS money available to fund outcomes rather than organisations. People talk endlessly about the NHS, and they absolutely should be talking about citizen health. It’s not about the organisation. The organisation is not an end; it’s what it delivers that’s important.

I’d like to see people shifting their focus, stop talking about the NHS, and start talking about public health and people’s experience of delivering both preventative healthcare and healthcare that responds to your needs. The reason our A&E departments are full is that in some places, you can’t get a GP appointment for three weeks. When you’ve got a problem, you need it resolved.

The other thing nobody acknowledges is this endless discussion about the private sector. GPs are private companies on contract to the NHS. Nobody ever challenges the fact they don’t necessarily always provide a service. We’ve just seen the five-year plan to try and use more GP services in care homes. We’re now getting kickbacks from GPs saying, “We need more money for this.” When a GP squeals “we need more money” to do something fundamental to citizen health, the government cave in. If a care provider says that, they say, “Just get on with it.” GPs are treated very differently to care providers, and they’re both private businesses on contract to the government.

In terms of the stakeholders and decision-makers involved, it lies squarely with the government at this stage, in your opinion?

I think it does. It requires a bit of leadership, but one of the things governments have to do is challenge people who are not prepared to change — power elite, local authority, commissioning departments, or providers who are currently not providing what people want. The whole system — providers, commissioners, government, and the NHS — needs to be challenged on delivering outcomes. If you challenge them on delivering outcomes and resources appropriate to the outcomes, you will have a much more flexible system, much better integration, and a situation where people were getting what they wanted.

How do you view the leaders of independent care today? How are they pushing this change?