These were just some of the findings reported at a conference held at The King’s Fund this week on the Total Place initiative, which looks at how a ‘whole area’ approach to public services can lead to better services at less cost. The event also highlighted the work of the 13 pilot programmes across England where local public service organisations are collaborating to see how public resources could be used more effectively.
So what would a place-based approach to spending mean for the NHS?
Thirty-four primary care trusts (PCTs) have been directly involved in the Total Place pilot programmes and the conference heard from participants in three sites – Coventry and Warwickshire, Birmingham and Bournemouth, and Dorset and Poole. The overall message is upbeat and while it is still a work in progress there is good reason to believe this approach could reach the parts that previous initiatives have not.
First, it could help to redistribute resources around the needs of places and people rather than organisations and their complex funding streams. By putting citizens at the centre of services and embracing the philosophies of personalisation and choice, Total Place is an integral element of public service reform.
Second, it can help to eliminate waste and duplication; local public bodies are often spending money on the same things. The Treasury has estimated that if these local bodies achieved 2 per cent savings in 2013-14 this would release more than £1.2 billion in England.
Third, it offers a different model for collaboration between the NHS and its local partners that could help rejuvenate tired partnerships and inject new life into efforts to join up health and social care. In the words of one contributor, it’s about culture as well as counting.
Finally, it’s an opportunity to recast a historically tense and ambiguous relationship between local public service organisations and central government. It could herald a new relationship based on freedom from central performance and financial controls, incentives for local collaboration, and investment in prevention. Allied with the new government’s commitment to localism this opens up the opportunities for stronger local leadership.
Yet it remains unclear how Total Place fits with the policy priorities of the coalition government. Their programme for government is peppered with references to efficiency savings, reducing waste and better collaboration between different parts of the public sector. If the new government is true to its localist word, it’s reasonable to expect that this approach will have a place in its programme. However, why would PCTs choose not to participate in place-based approaches? Even now there is nothing to stop them; it could offer a powerful boost to long-standing aspirations for care closer to home.
But it won’t be easy. Redesigning the use of public money around people and places instead of organisations will demand radical change. Delegates underlined that engagement of the workforce will be crucial, and it’s far from clear what role GPs, with strengthened commissioning powers, would play in a place-based approach. It seems clear however that whatever we choose to call it, Total Place is part of the solution for the NHS and not part of the problem.
PDF version Government efforts to reduce the numbers of dementia patients entering hospital will include the introduction of a fixed-fee tariff for providers of community care.
The policy was announced by health minister Earl Howe last week in response to a question in the House of Lords, although details of how it would work are yet to be released.
Under the payment by results policy, the Department of Health already operates tariffs for hospital treatment for Alzheimer's patients and a variety of medical procedures, under which providers are paid a flat rate for treatments.
The system aims to drive quality and efficiency by paying providers only for the work that they do rather than in block grants.
Howe said the government was seeking to ensure the five-year National Dementia Strategy was sustainable. "We will do that principally by driving up quality standards through a tariff for dementia patients, by better regulation of providers and by better commissioning of services, including public health interventions," he said.
Baroness Greengross, who tabled the debate on dementia, said Howe had told her that the introduction of a tariff was "high on his list" of priorities.
Ruth Sutherland, acting chief executive of the Alzheimer's Society, said money was often squandered on poor dementia care and the tariff could transform care and save money.
Simon Williams, dementia lead for the Association of Directors of Adult Social Services, said it was a positive step. He added that the NHS would need to take a broad look at how it improves care, saying: "A tariff is one way of helping but it's not the only way."
Full details of the tariff are expected from the Department of Health in the coming weeks.
In last week's Lords debate, Howe also said that the government's priorities for dementia care would be reducing the use of antipsychotic drugs, promoting early diagnosis and improving the quality of care in care homes and hospitals.
Related articles
Scots aim to transform dementia care but with no new money
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http://www.communitycare.co.uk/Articles/2010/06/07/114664/tariff-system-...
overnment efforts to reduce the numbers of dementia patients entering hospital will include the introduction of a fixed-fee tariff for providers of community care.
The policy was announced by health minister Earl Howe last week in response to a question in the House of Lords, although details of how it would work are yet to be released.
Under the payment by results policy, the Department of Health already operates tariffs for hospital treatment for Alzheimer's patients and a variety of medical procedures, under which providers are paid a flat rate for treatments.
The system aims to drive quality and efficiency by paying providers only for the work that they do rather than in block grants.
Howe said the government was seeking to ensure the five-year National Dementia Strategy was sustainable. "We will do that principally by driving up quality standards through a tariff for dementia patients, by better regulation of providers and by better commissioning of services, including public health interventions," he said.
Baroness Greengross, who tabled the debate on dementia, said Howe had told her that the introduction of a tariff was "high on his list" of priorities.
Ruth Sutherland, acting chief executive of the Alzheimer's Society, said money was often squandered on poor dementia care and the tariff could transform care and save money.
Simon Williams, dementia lead for the Association of Directors of Adult Social Services, said it was a positive step. He added that the NHS would need to take a broad look at how it improves care, saying: "A tariff is one way of helping but it's not the only way."
Full details of the tariff are expected from the Department of Health in the coming weeks.
In last week's Lords debate, Howe also said that the government's priorities for dementia care would be reducing the use of antipsychotic drugs, promoting early diagnosis and improving the quality of care in care homes and hospitals.
Related articles
Scots aim to transform dementia care but with no new money
Coalition deal: Victory for Community Care dementia campaign
http://www.communitycare.co.uk/Articles/2010/06/07/114664/dementia-care-...
The first three NICE quality standards covering stroke care, dementia care and prevention of venous thromboembolism (VTE) were presented to the Secretary of State on 30 June 2010. The letter below sets out the National Quality Board's advice to the Secretary of State on how these and future quality standards can become a central, underpinning element, of the whole quality improvement system for the NHS.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/De...
Dementia is the process, in which the brain cells of a person get damaged, and his mind is not working properly, Alzheimer’s is the best example of Dementia. Person affected with dementia has some mental disorder also, which needs the Dementia Care.
Symptoms of dementia may lead to lack of abilities in certain areas such as problem solving, loss of memory and confusion. Dementia is often found in elderly people as a harmful side effect of some mental illness, such as Alzheimer's, and might reflect as an after-effect of a medical treatment. The main cause of dementia head trauma, vitamin deficiency.
But does empowering patients to choose their hospital lead to improvements in services? Patients have had a limited choice of hospital for more than four years and the ability to choose any eligible provider – private or NHS – since 2008. The King’s Fund has been working with the Picker Institute Europe, RAND Europe, and the Office of Health Economics to look at the implementation of this policy and what impact it has had on providers. Today we publish a report of that research: Patient choice: how patients choose and how providers respond.
We found that most patients think choice is important, but only half are offered one. Very few patients look at published performance information to help them choose. Most select their local hospital but some patients, particularly those who’ve had a bad experience, choose to travel to an alternative.
The threat that patients could go to another hospital and the fact that personal experience is a key influence of choice has, in some cases, sharpened the focus of providers on improving the experience for their patients. However, we also found that hospitals are not yet actively seeking to attract new patients as a result of choice.
In the future as tighter economic conditions lead PCTs to curtail demand for hospital services, we expect hospitals to compete more for patients’ custom. But the providers we spoke to last year faced high levels of demand and were more focused on meeting the 18-week waiting time target.
Empowering patients to choose a hospital is not yet a strong driver of service improvement within health care; it remains to be seen whether it will be in the future. But choice seems to be what patients want and the coalition government is committed to giving them more of it.
http://www.kingsfund.org.uk/blog/its_a_question_of.html