A new Secretary of State for Health and Care: three tensions he can recast

By - Integrated Care Journal

A new Secretary of State for Health and Care: three tensions he can recast

The new Secretary of State for Health and Care arrives at a remarkably interesting time. Problems that had ground to an intractable halt may yield to different approaches. A more commercial background may apply fresh thinking to old problems. As we hover between the end of lockdown and the successful introduction of Integrated Care Systems, the government has a chance to rethink the past and reshape the future.

Here are three tensions that our new Secretary of State for Health and Care faces and is unusually well-positioned to address.

Health v wealth 

The struggle between the Department of Health and the Treasury has been a major feature of the crisis and for a while it appeared that we were doing worse that the rest of the world of both fronts. Surely someone who has been at the helm at the Treasury and Health will have a more balanced view of the challenge.

Whatever the final analysis shows (and it may take a year or two to come out), colossal damage has been done to swathes of our commercial infrastructure and educational systems (not to mention the pupils and students going through).

As the ‘war on the virus’ gives way to a more measured rhetoric on retrieving a better normality with or without (but probably with) the virus, it is becoming clear that we have survived under a false dichotomy: we have to make health and wealth work together.

Exactly how he makes this happen, will depend upon how our new Secretary of State for Health and Care muscles his flexibility, but he comes to the fore at an opportune moment.

Funding v investment 

Coming from a banking background, the new Secretary of State for Health and Care brings an investment perspective to the table. The conventional thinking around NHS finances is of a fair distribution of funding, rather than the potential for investment.

The NHS is not an engagement ring offered to a grateful public by a governmental suitor, nor is it worth more if it costs more. The NHS is a service we pay for, and some have paid particularly dearly over the past 18 months.

The perspective of an investor can be more generous and harsher than that of a fund-distributor, since investors look at money very differently. Whatever happens, the new Integrated Care Systems (ICS’s) are going to cost a lot to make them work well. We know that payment systems need to shift in favour of outcomes and away from rewarding activity or mere size, so fresh thinking is needed. However, ICS’s also have enormous potential for benefit at scale, and the right designs will be worth the investment.

Over the past two decades, NICE has promoted value-for-money at the heart of investment decisions. I am a great admirer of NICE and the methods by which it assesses value, and I hope that value-for-money thinking embeds itself ever more deeply in the NHS. However, there is still a problem in that economists can spread calculations over many years, while businesses must make decisions here and now. The way is open for someone with strong investment credentials to build better decision-making onto NICE’s foundation.

Health for all v personalised care 

The language around this tension keeps changing, but at heart it involves programmes of broad benefit that reach everyone and services that meet the needs of individuals. Mass customisation in manufacturing persuaded many in health that they can have the benefits of large-scale provision and individual attention at the same time.

The pandemic provided a wonderful opportunity to showcase and refine personalised delivery but pushed the NHS into large-scale delivery of vaccinations instead (an undoubted success to date). However, we are recognising ever more groups whose personal health has been a casualty of the crisis.

The NHS has learned about industrial process through the pandemic (e.g. queue-free delivery environments) and has both successes and failures to inform future reform. There is now an opportunity to extend this quasi-industrial experience into care closer to the patient. Someone new may enjoy more freedom to recognise the setbacks of the pandemic alongside the successes and mediate a better balance for the future.

One clear message of the pandemic is that better decisions need better data, so someone needs to drive demand for better real-time data.

A new opportunity 

The pandemic has created an unusual perspective from which to view healthcare. As we sit on the threshold of an era of greater freedom and the prospect of integrated care, the new Secretary of State for Health and Care has the opportunity to recast some fundamental tensions around health in a much more positive way.

We wish him well.

About the author

Professor Terry Young worked in industrial R&D before becoming an academic and is now Director of Datchet Consulting. With over 30 years' experience in technology development and strategy, health systems, and methods to ensure value for money, his current focus lies in designing services using computer models and he set up the Cumberland Initiative to support healthcare organisations wishing to develop their services more systematically.

Three of his downloadable papers are:

Using industrial processes to improve patient care (2004, with Brailsford et al., British Medical Journal)

Performing or not performing: what’s in a target? (2017, with Eatock & Cooke, Future Hospital Journal)

Systems, design and value-for-money in the NHS: mission impossible? (2018, with Morton and Soorapanth, Future Hospital Journal)

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