Andrew Palmer: Society is changing... and so should the system of NHS care

NHS spending has tripled since 1996 but it clear that, no matter what political ring-fencing is applied, the age of ever increasing health budgets is over. But despite the funding challenges, standing still is not an option for the NHS. Health needs will continue to change and so should services to address them.

New treatments, better clinical practice and new drugs and technologies are changing the way care is delivered. Patients' needs are changing too as a result of demographic trends and lifestyle choices.

The solution, as ever, is to do more with less, finding ways to reduce the cost of healthcare without compromising on the quality of care. If it sounds impossible, there is already growing practice that is showing the way forward through earlier diagnosis and prevention, through a replacement of unnecessary hospital admissions with treatment in the community.

And while "change management" programmes have often stalled or produced only temporary effect, examples exist where staff have been

successfully engaged in and are committed to the redesign of services to deliver more.

We make a mistake if we assume that more spending means more success. The NHS today has an excessive reliance on hospital inpatient care and A&E department use. Instead of paying for activity in hospitals, we should be paying for treatment that produces the right outcomes – improvements to a patient's condition or health.

And we have the opportunity, if we embrace the need for redesign, to greatly increase the service received by patients. Walk-in centres on the high street and near places of work will allow more people to access NHS care earlier, ensuring undiagnosed conditions are not left to worsen.

Providing care closer to people's homes or in their home is not about asking vulnerable people to fend for themselves. Outreach teams, technology and individual care plans can ensure that the right help is on hand when it is needed, avoiding hospitalisation. And empowering patients, through health education, to be involved in the management of their own condition, with expert support, can allow them to keep independence and confidence.

But this sort of change can only happen if we also empower NHS staff to provide support to patients in their homes and communities. For them it should mean more time spent with patients who really need their

attention.

There is much good practice already that can be spread more widely, and in many cases the NHS has worked with outside partners, in the

voluntary and business sectors, to design and deliver new forms of health services.

Boots now have NHS GP-led surgeries in 10 of their stores, which

provide primary care GP services to registered patients and also a walk-in service to non-registered patients from 8am to 8pm, 365 days of the year. In one centre, services such as dietetics, an acute back pain clinic, physiotherapy, podiatry and a GP branch surgery are all based together under one roof alongside Boots pharmacists.

Elsewhere, with other partners, telehealth solutions have been developed for patients with chronic pulmonary disease. Monitors are installed in the homes of high-risk patients measuring vital signs such as heart rate, weight, blood pressure and oxygen levels. Data is transmitted to central monitors in secondary care and the health care staff monitor the "virtual ward" to prioritise the home visit schedule.

This trial reduced hospital admissions by half and home visits by 80 per cent, allowing staff to spend time with the patients that needed the care most. In Yorkshire and the Humber, Tunstall is leading the way working with Sheffield PCT for example.

And, in another area of high social deprivation, Sheffield-based A4e is working to deliver a new approach to community midwifery. Services include a more flexible programme of parent education and drop-in for maternity advice. It also offers pre-conception care and advice, whole antenatal care, and breastfeeding and post-natal care continues until the child is 12 months-old. The ultimate aim is to catch people upstream and impact on infant mortality, as well as reducing visits to A&E. Targeted outcomes are increased breastfeeding rates, reduced numbers of women smoking during pregnancy, and ensuring all women are seen at an early stage in their pregnancy.

The message from these examples is that sometimes a rethink is needed on where and how the money is spent to deliver the optimum outcomes. Is it possible to reduce the demand in the most expensive parts of the system by getting to patients earlier, and if so how does the system need to be redesigned to do that, and which organisations are best placed to achieve the outcomes?

This sort of thinking is now taking place in the NHS, and needs to be radical. And, as budgets tighten, it is the type of approach that other public services will need to adopt.

Andrew Palmer is the regional director of the CBI.