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Paul Najsarek: Seven principles for health and social care reform

Paul Najsarek
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The pressure on both the health service and local government to deliver appropriate support both promptly and adequately, while having to make enormous savings is well documented.

But this pressure, combined with competing priorities, can result in two partners who need to work more closely having different views on how they can best achieve the outcomes they must deliver.

Given the risk that focus can be on short-term fixes and partial solutions, it is even more important to keep an eye on the principles that should guide our long-term thinking.

Recently the mayor of London identified six key principles for proposed NHS changes in London, based on evidence from the King’s Fund. Building on these, I suggest, when considering any health or social care reform or funding proposal, locally and nationally, there are seven tests that should be applied.

  1. Resident engagement and communication: A sustainable system will need the support of those who will use it and will need them to make lifestyle changes. Open engagement is imperative to achieve this.
  2. Outcomes and community focus: It is all too easy to become preoccupied with the technicalities of reform and institutions when our attention should be directed on resident impact, wellbeing and inequalities. Our health and care funding is an investment in the social and economic outcomes of our communities.
  3. Subsidiarity and devolution: The assumption should be that improvement should be led as close to the patient/user as possible, with national and regional reform and funding enabling change.
  4. Credible business cases: Our users are often extremely vulnerable and at very sensitive points in their lives. This is a reality that demands careful and credible plans rather than transformation rhetoric.
  5. Articulation of benefits: What is most needed, right now, is investment and improvement in community services and prevention activity. Focusing on the benefits of changes for staff and residents should be the immediate concern.
  6. Whole systems: Any solution should bring and be judged on its ability to bring us closer to making the whole system work, not its effectiveness in successfully competing for resources in order to make just a part of the system work.
  7. Sustainable funding: Reform and improvement are crucial, but alone, without a short and long-term funding solution to go with it, will not produce the high quality outcome our residents expect and deserve.

The autumn budget is looming, as is the promised consultation on social care. I suggest these seven tests need to be kept in mind as current changes in health and social care are implemented, and also as guide and judge for future reforms and spending decisions.

Paul Najsarek, chief executive, Ealing LBC

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