Bringing it all back home

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 Will the new NHS deliver effective community-based healthcare or revert to the old fire-fighting approach? Maxine Vaccine asks whether a cheaper healthcare model is something the NHS can afford.

Healthcare in the community is an idea whose time has come. It’s not new, of course: preventative care and avoidance of hospital admissions were strong themes in the Darzi review. For years, the NHS has been talking about a radical change in the healthcare model: from acute to chronic, from fire-fighting to safer housekeeping.

What the new austerity has done is to impose a financial imperative on the change. The general principle that prevention is cheaper than cure has to be hard-wired into patient pathways that deliver measurable cost savings. That may work readily for a condition such as COPD where the clinical and financial stakes are high – but does it work every time for obesity, for diabetes, for depression? The problem with mixing austerity and community healthcare is that you need to pay up front for primary care, for prevention, for monitoring and control, and the savings appear further down the line. Which is not the way business tends to work.

The Government has taken some positive steps towards integrated care. The decision to allow physiotherapists and podiatrists to prescribe independently may seem a minor step, but it’s unprecedented (not just here, but worldwide) and it bridges the gap between primary and secondary care, giving the outpatient clinic a decisive power of intervention that addresses a key weakness in long-term condition care.

On the other hand, the worrying prevarication over the Dilnot recommendations highlights concern that shifting responsibility for public health to local government is merely a way for the coalition to go on claiming it’s not cutting the NHS budget – when it is, of course, slashing the local government budget to ribbons, and social care is bearing the brunt of that. Our hospitals are increasingly packed with ‘revolving door’ patients who, until recently, would have been cared for by social services: alcoholics, drug addicts, the mentally ill, the disabled, the elderly.

So the wheels are in danger of coming off the Government’s model of community-based care. Even GP-led commissioning – this Government’s flagship health concept – may ultimately be disabled by austerity culture. There’s a growing sense that CCGs exist to cut costs, not to improve care – and GPs don’t have the time or the stomach for that. If the balance between clinical and financial outcomes tilts too far towards the £ side then CCG management will be outsourced, and the circle of private providers and private commissioners will be complete.

But whether it fully works or not, community-based healthcare is what the realities of patient need dictate. Whether you’re looking at mental health, diabetes, obesity, sexual health or the effects of smoking, the message is clear: the NHS needs affordable strategies to keep people well, keep them out of hospital and, where possible, keep them looking after themselves.

Integrated care means not just the integration of health and social care, but that of primary and secondary care, and that of different therapies. Pharmaceutical companies need to see drug interventions as part of a multi-faceted patient pathway in real time. They need to see diagnostic and device companies, physiotherapy and psychotherapy providers, as partners rather than as rivals. In hard times, nothing of value should be wasted.

Making the best of what’s available by combining talents and resources is the future of the NHS. It needs to be the future of the life science industries as well.

Maxine’s views are not necessarily those of Pharmaceutical Field.