Don’t talk about the money?

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Don’t talk about the money?

This post is from The King's Fund Blog

At Healthwatch Essex, I’d like to think we’re pretty clear on what we do. We are ‘an independent voice for the people of Essex… helping to shape and improve health and social care’. We do this by capturing people’s lived experience and then using this insight to make a positive case for change.

One of our unwritten rules has always been: ‘Don’t talk about the money.’ This hasn’t been easy, and there are plenty of people in the media and from interest groups who would have us lobby for more cash for the NHS and/or social care. But I’ve always resisted this. Funding is, after all, a matter for government. Getting involved in political arguments could compromise our independence, and doesn’t hold much sway with the people we’re trying to influence either – local NHS trusts or commissioners, for example, who don’t determine their own budgets anyway.

So our focus has always been on capturing a close and empathic understanding of people’s needs and day-to-day experiences of care. By doing this we can then work with system partners to help find solutions to the challenges – small and large – that we face as a health and care system. We believe that orienting care more closely around people’s needs, and finding out how people can care better for themselves, are ways of both improving quality and saving money.

But as the recent report from The King’s Fund shows, financial pressures in the NHS are starting to impact negatively upon people’s experience of care, often in ways that seem invisible to the usual statistical measures of performance or quality.

Healthwatch’s qualitative research often uncovers cases of poor or sub-optimal care, where the root of the problem can be seen (in part) as a lack of resource. Examples can be found across sectors and organisations – such as when people experience poor discharge from hospital. While this frequently manifests as delayed discharge (often caused by different agencies disagreeing over resources), we also encounter premature discharge, or people who simply disappear off the radar once leaving hospital only to reappear in a time of crisis.

But it’s in stories from the community where care compromised by resource constraints is often most evident. In Essex we hear about older, often vulnerable, people who would rather not present to their local GP practice at all than see the locum doctor. Or people with evident care and support needs who don’t meet apparent thresholds, such as those who can hardly walk being told they can’t access district nursing services unless they are housebound – even though they’re unable to get to their GP surgery. Or people seeking support for their alcoholism but being unable to locate or access the right service. These are just a few insights into the impact on individuals of financial pressures in the health and care system – that might otherwise go unseen were it not for Healthwatch organisations around the country listening to people’s lived experience.

So what can we do? I remain optimistic that the NHS five year forward view and the sustainability and transformation plan implementation process can help local systems to rebalance their health and care economies, based around a sound understanding of local population health and care needs. This could, and should, include reallocation of resources away from expensive, reactive care to more appropriate, preventive, community-based care and primary care. And doing nothing is certainly not an option – we all need services that are financially sustainable.

But until this happens, will we just see more of the same? Is it finally time to talk about the money?

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