Articles

Missing you Down Under

Dr Johnny Marshall's blog:

It's 6 a.m. and I am up bright and early watching the London 2012 opening ceremony, #proudtobebritish. The Australian TV commentators marvelled at the NHS being such a feature of the celebration of British culture and reflected that "Medicare" was never going to be given pride of place in Sydney 2000. They concluded that the whole event was "sensational", "quintessentially British and bonkers"! Praise indeed!

In fact I've been awake for a while. I missed the NHS Commissioning Board Future Design Group this week as I was addressing the World Healthcare Network Conference (#WHCN) in Cairns. The key purpose of the conference was to exchange information and insight about developments in healthcare networks from around the world. In Australia they are also undergoing healthcare reform that enhances the role of GPs in healthcare planning, building on organised networks in General Practice to create Medicare Locals. Limited budgets aimed at specific national priorities are being allocated to Medicare Locals with which to procure new local services. Perhaps the most concise way of describing them is something akin to previous incarnations of clinical commissioning in the UK, a combination of Primary Care Groups (PCGs) and Practice Based Commissioning (PBC). There were many of the Australian Medicare Locals present from which to learn and with whom to share our Clinical Commissioning Group developments. It seemed like a good use of study leave.

The conference began with an Aboriginal "Welcome to country". Afterwards many delegates reflected on the intimate knowledge that the Aboriginal community have of their land, down to individual rocks, and drew a parallel with the degree of understanding of the health needs of our populations that our health systems need to develop.

Prof Jeffrey Braithwaite, Australian Institute of Health Innovation, presented some evidence about networking as a vehicle for improving multi-professional working. It seems that it is disappointingly ineffective and that the power of tribalism seems to be all conquering. Those people who are able to span the boundaries between different tribes are invaluable in holding groups together, even more reason for healthcare systems to be investing in this type of clinical leadership. In addition, restructuring can disturb natural networks that are developing. This can prove costly even if they are not fully functioning as much of the benefit of networks takes time to develop. I was left in no doubt by delegates that the NHS has an international reputation for restructuring!

Melissa Sweet (@croakeyblog), one of Australia's most experienced health reporters, challenged us to think more widely than simply professional networks and to consider how we genuinely engage people in both their healthcare and the development of healthcare services, particularly by tapping in to the potential of social media.  She spoke of the importance of turning data in to stories that people can truly connect with and signposted valuable and concise advice on how best to use Twitter from the London School of Economics. We heard later on in the day that the US Defence Services also had a great Twitter guide but I could not find this readily on-line!

If you ever have the opportunity to listen to Jason Cheah, CEO of the Singapore Agency for Integrated Care, then my advice would be to seize it with both hands. He ran us through the Singaporean health system. Although no more perfect than any other, it is making enormous strides in delivering a working model for the integration of care by bridging the gaps between tertiary, secondary and primary/community care settings that patients so often fall through. One example was the Singapore Programme for Integrated Care of the Elderly (SPICE) which enables frail elderly who have high care needs requiring residential care to recover and age within the community. I will definitely be following up with Jason to discover what we can learn from each other about incentivising acute hospitals to work with others to ensure patients remain out of hospital for all the right reasons.

Hal Wolf from Kaiser Permanente (KP) articulately illustrated why an electronic medical record accessible by all clinicians was an essential pre-requisite to coordinated healthcare. This seems to be something that the NHS in many respects is ideally placed to deliver but is taking more than its fair share of time over. Without it our aspiration of more integrated care will prove more difficult than it need be and it seems clear that NHS England risks underestimating this at its peril. Several parallels were drawn between KP and the NHS, both celebrate the same year of birth, and several delegates quoted the research findings that KP outperforms the NHS. Perhaps the reality is that KP represents some of the highest quality in healthcare provision and the NHS represents some of the highest quality in healthcare systems. We both still have much to learn from each other so that we can further improve health outcomes for our populations.

On the final morning Professor Jan De Maeseneer, Head of Primafamed, Ghent University Centre and Chair of the European Forum for Primary Care, presented a challenge to the conference and to the world. Increasingly it would seem that individual disease investment in developing countries is resulting in disease inequity, which in some circumstances results in children having variable access to food aid depending on the illnesses that their parents have. Furthermore, at a time when developing countries need more coordinated Family Medical Services, developed countries continue to drain them of qualified doctors with no compensation for their training costs; how's that for increasing health inequality? The room was charged at the end of his presentation and left with a new cause that their regional network might wish to champion.

Mayor Bob Parker, Christchurch City, New Zealand, delivered an emotional account of the healthcare response to the earthquake in 2011 with video clips of both the moments the earthquake struck and the immediate aftermath. It was clear to him that relationships within networks are key at times of such chaos. He was followed later on in the day by our very own Rt. Hon Alan Milburn who left delegates in no uncertainty that "health" and "crisis" regularly appear in the same sentence across the world whatever language you speak.

One final thought, and one of the quotes of the conference, came from the conference facilitator, Feyi Akindoyeni, “A committee is a cul-de-sac in to which ideas are lured and strangled”. A timely reminder for all of us as we seek to establish new networks and healthcare systems seeking to unleash innovation!

If there was a take home message for me then it was the importance of thinking outside of our own world, however big or small and whether professional or geographical, in developing solutions to shared healthcare problems. The common themes that seem to run though all healthcare systems are the need for highly organised Primary Care, strong clinical leadership and an accessible Electronic Healthcare Record. NHS England needs to make sure that it has invested the necessary time and effort in developing all of these if the potential of the NHS England reforms are to be fully realised in improving health outcomes through greater coordination of healthcare around the needs of individuals and populations.

Footnote

Medicare is Australia's publicly funded universal healthcare system.
Primafamed is coordinated from Ghent University, Belgium, and supports African universities in their set up or improvement of primary healthcare education.