WIREDGOV

Report from the Independent Commission on Whole Person Care on behalf of the Labour Party

In 2014, the NHS and social services work very hard to deliver a model of care that was created for a different population, with different diseases. This involves providing a wide range of often good episodes of care, aimed at improving the health of individual body parts, but which do not meet the needs of our ageing population. At the moment 70% of the health and social care budget is spent on older people with long term conditions, and much of this considerable resource is not well spent. The crisis for the NHS and social services is that in order to meet the needs of our population today and in the future, they need to radically change the model of care; but are finding it very hard to do this.

Within the world of health and social care policy, few people disagree with this diagnosis of the problem.

The people who now need the most care are older people with long term conditions, who will need personalised, co-ordinated care for the rest of their lives. The case for change is most strongly voiced by people themselves. The Commission has heard this case, and argues for a radical new approach over the next Parliament, to re-work our health and social care system to meet these needs. Behaviours will have to undergo radical change, with the needs of one person being addressed by health and social care staff acting as one team, working for organisations that in turn behave as one system.

Most people agree that this change to co-ordinated care is necessary, but in 2014 the vast majority of care is still fragmented and episodic and does not meet the needs of the patients

It is vital that the next Government leads this change, and does so without a complete reorganisation of the structures of NHS and social care. The recent reorganisation has left the NHS and social care demoralised, and struggling to understand the system within which they are meant to be working. A further reorganisation in 2015/2016 would place the whole system in very great peril.

The next Government must dedicate itself to improving health and social care outcomes for patients and service users, with outcomes defined with and by patients and service users themselves. Government leadership is needed to change how the organisations that provide care actually behave, rather than passing legislation to change how they are structured.

Given most policy people agree with the problem - and agree what the new model of care should be – the failure to bring about this radical change comes from a failure to take on vested interests and fully implement the change.

We have 6 groups of recommendations that the next Government need to introduce, in providing services, getting the right people working in the right way, information solutions for whole person care, keeping people healthier and independent, making the money work, and wider system changes. The majority do not need legislation. Examples are provided below:

• We need to give meaningful power to patients, the families and carers to play a role in shaping their coordinated care around their needs.
  
  All of the major patient’s organisations quite rightly make the case that patients, their carers and their families should play a much bigger role in coordinating their own care. To be able to achieve that they need more power. We recommend that:
  
  1. People own and control their own electronic records
  
  2. Local citizens as of right are involved in the design of local services
  
  3. Payment to providers is based upon how well they have met outcomes as defined by the user of the service
  
  4. Staff are trained and assessed in how well they help people co-manage their conditions.

• If we are to succeed in reorienting the whole system around the real needs of the population we will need to empower patient organisations to play a full role in this process.
  
  The Richmond group of patient organisations and National Voices have a clear understanding of both what needs to be done to create whole person care and how difficult this. We recommend patient organisations are involved meaningfully in central policy generation, for example as secondees to the process.

• We have a system that treats and commissions services around body parts, and the care needs of someone separate to that. This is poor care, but also wasteful of money. Part of the solution is viewing local resources, health and social care together (the "locality pound") and creating a collective commissioning plan using those resources to deliver outcomes defined by the people using the services.
  
  The money must also work differently, so that incentives align behind whole person care. The current payment system incentivises episodic care and admissions to hospital. We recommend changing that to capitation payments for a year of care for this group of people, whatever happens. This enables more care at home.

• Additionally, at the moment doctors are better rewarded for treating patients as if they have individual parts of diseases and not the whole person. This encourages doctors to stay within the old model of care and not treat the whole person. We recommend working with the Royal Colleges to change the merit awards within 2 years to provide incentives for doctors to provide coordinated whole person care as the pinnacle of their profession.
  
• £1 billion of public money is spent on clinical research, yet very little on how to manage the people who comprise the majority of activity in the health and care system. Existing research also biases quality standards to body parts, and against whole person care. We therefore recommend from existing resources the establishment of an internationally connected research centre on managing people with complex needs.
  
• We share the English people’s commitment to an NHS funded out of national taxation, with equal access for all, and free at the point of need. The country does not have the public resources to spread those principles to social care. In the first year of the new Government we would recommend a national conversation on the scope, provision and funding of health and social care together. Given the public’s commitment to the NHS and its principles, this conversation is required to maintain those principles into the future.

The current system does not serve people with multiple long terms conditions, frailty or disabilities well. Just as the last reorganisation of the structures of the NHS alongside the cuts in local Government finance has failed to change that, we are also certain that a further NHS structural reorganisation will also fail to develop a coordinated care service. Relationships and culture trump structures. Our whole system recommendations may not be as visible as scrapping one set of organisations and creating another, but they tackle biases in the system that will make real differences to the day to day experiences of people using the health and care system. This is about service change not structural change.

The Chair was Sir John Oldham. The members were Sally Brierley, Hilary Chapman, Angela Coulter, Marian Dinwoodie, Peter Hay, Jeremy Hughes, Donal Hynes, Ian Philp, Richard Smith, Jay Strickland. All members took part in a personal capacity.