Fantastic news to
start the week, and the first major success for the Healthy Norwich
project. Back in February we pledged £100k of match funding, and full
CCG support to the City Council in their application for a cycling
ambition grant from the Department of Transport. Norwich has been
awarded £3.7 million as part of a total fund in excess of £5 million to
build a cycle lane right through the city. This is not painting a bit of
the road a different colour - it is a full transport redesign, that
will allow an unaccompanied 12 year old to cycle safely across its
entire eight mile route.
This is a genuine
good news story, but I still found myself thinking about a possible
media response - is this how health money should be spent? How many
pills/operations/nurses would that have paid for? My answer comes from a
talk from Dr Thalange - Consultant Paediatrician at the NNUH, and a
passionate advocate for lifestyle improvements in the fight against
diabetes. He spoke of the obesogenic city, the rise of diabetes in
children, and the terrible human and financial cost. CCGs at their best
impact on the long term causes of premature illness and death, and in
health terms, the return on this investment may make it the single most
important thing we have done since we were formed.
On a smaller scale
we wrote success letters to 21 bidders for Healthy Norwich micro-funding
(maximum £5k) to pay for new projects to advance the Healthy Norwich
agenda. There are some great ideas in here, with the voluntary sector
the single largest source of bids. Some examples:
- Community Gardening for Homeless Clients
- New local charity to raise awareness and promote self-examination for testicular cancer
- A cycle workshop to help people on low incomes build and maintain bicycles
- Drug, alcohol, and smoking - raising risk awareness in schools
- Support and education for teenage parents
There's a lot of
activity and effort here for a very small investment - much of it
delivered by volunteers, and I wish every bidder success with their
project.
I received an email
via our website back in March, from a Norwich resident. She set out in
clear, articulate, and dispassionate terms the experiences of her 92
year old father after he fell in the garden and broke his pelvis. It was
uncomfortable reading, and highlighted the consequences in very human
terms, of how an urgent care system - despite the best intentions of the
professionals that deliver it - can fail a patient. I finally met her
today, and we spent an hour discussing how her father's health and care
had progressed, and how we could use her experiences to improve care
going forward.
Her words
pre-empted those of the Ombudsman's report - she would not formally
complain because the thought of all the bureaucracy, denial, obfuscation
that she might experience made it feel like all pain no gain. I don't
know if this would have been her experience, but if that is the
perception we have a problem. Complaints are vital to service
improvement, and patients need to believe that complaints are welcomed,
listened to, and acted upon.
However, she is very interested in joining our Urgent Care project, and I hope to persuade colleagues to support her joining our Urgent Care Network as a patient representative. I believe she will add real constructive challenge to our work, the pace of improvements, and the impact of change on patients and their care.
However, she is very interested in joining our Urgent Care project, and I hope to persuade colleagues to support her joining our Urgent Care Network as a patient representative. I believe she will add real constructive challenge to our work, the pace of improvements, and the impact of change on patients and their care.
WEDNESDAY/THURSDAY
Met with Ernst
& Young - and then the Head of the BDU on Thursday - as we work to
develop options for a long term effective and affordable model for
commissioning support. We should get an options paper in the next couple
of weeks, amid signs of emerging flexibility in terms of possible
models.
I have long been in
favour of the concept of commissioning support, because it helps the
solve the tension that has been at the heart of so much health system
reconfiguration: localism versus scale. In terms of responding to the
needs of our population Norwich CCG is about the right size - it serves a
city and suburban population of about 200,000 people, people who have
homes, jobs, and social lives based in the city. It's a community we can
begin to understand in terms of health needs and health inequalities,
and we have started to design and purchase services to meet its specific
requirements.
However, our main
providers cover much wider areas - ranging from the central region of
Norfolk (3 CCGs) to the entire East of England (19 CCGs) and much of our
contracting and quality assurance work is far less efficient if we do
it separately. Reconfiguring services such as pathology or acute stroke
care involve multiple CCGs, and there are good arguments that generic
technical services such as IT, data warehousing, and invoice processing
can achieve huge economies and improved performance from working at
scale. And so the NHS commissioning structure (and I have seen this
repeated in the private sector as well) - starts small in times of
confidence and enthusiasm, and then gradually merging to chase
efficiencies, greater control from the centre, and the consolidation of
financial risk.
Commissioning
support units may therefore offer a way to provide economies of scale,
and centres of specialist support, while allowing CCGs to remain small,
focussed on local priorities, and able to seek and respond to the needs
and views of the community they serve. For true commissioning support
(co-design, procurement, contracting, financial and performance
management, quality assurance, and business intelligence) an open
marketplace is very difficult to foresee - if partner CCGs purchase
these from different suppliers it adds rather than reduces complexity
and cost. CCGs shopping around also creates significant risk for
suppliers, which tends to be reflected in service cost - I know from my
time in consultancy that the shorter a contract the higher the daily
fee.
So the suggestion
that a partnership model may be permitted - based on a long term
relationships rather than commercially procured services - is very
welcome, and may provide an answer which allows the Anglia CSU to
survive and thrive, and enable CCGs to remain small enough to hear and
respond to the people they serve.