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December 4, 2015

Welsh Institue of Health and Social Care Blog
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» Walking Backwards for Christmas

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy Glyn Griffiths is one of the noble band of WIHSC Associates on whom we rely for much of our work.  A pharmacist by training, and a … Continue reading

February 9, 2011

Welsh Institue of Health and Social Care Blog
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» History teaches us that working together works

It’s useful, now and again, to look back on our past successes. 

This is not just to make ourselves feel good – although a little bit of that now and again does no harm – but to learn the lessons of the past.

To twist a phrase, those who don’t learn the lessons of history are doomed not to repeat them.

Almost at random, let’s look at three different successes which NHS Wales (and its partners) can justly claim from recent years, and see what they might teach us about the future.

First, learning disability services:

Almost a generation ago, the NHS and social services in Wales changed the face of services for this client group. Working together, they moved people out of Victorian institutional warehouses into housing in normal streets up and down the country and put services in place to support them there.

At the heart of this success was the sort of genuine joint working that we need now across most of health and social care.

The agencies overcame their many differences and worked together on a common goal because the Welsh Office (as it then was) made joint working all but compulsory and provided clear cash incentives to do so.

Secondly, the abolition of waiting times:

This massive achievement in our current decade is of historic proportions.

Within a few years, people’s biggest and oldest bugbear about the NHS – inordinate waits for treatment – was ended. Why? Because for once we bent every sinew to the task, we matched this with resource and we stuck at it until the task was achieved.

Thirdly, the 1,000 Lives campaign:

This is still very much in progress – in the guise of the five-year, 1,000 Lives Plus programme – but it has already achieved impressive improvements in the quality and safety of care in pretty much every hospital across Wales.

The lesson here is that if you can find a cause which unites both the professionals and the managers, you’ve got a good chance of getting somewhere.

The win-win – better care and greater efficiency – must also be good news for patients and taxpayers too.

You could also add to this happy trio the huge improvements in dental health we’ve seen over the last couple of generations – most children now have no fillings, compared with the serried rows of grey metal in their parents’ mouths – and the huge growth in GP and community services.

These two examples show what can be achieved when we get patients and services to work together, for example applying fluoride each day and regular visits to the dentist, and by lining up the resources and incentives in GP services.

So what does this teach us for the future?

Five lessons of great relevance – make joint working unavoidable; get patients and professionals to work together; find common ground for clinicians and managers; line up incentives and resources; and choose a small number of priorities and stick with them.

History tells us this is all possible.

A quick glance through the rest of this newspaper tells us that it’s now more necessary than ever before.

Written by Professor Marcus Longley, Director and Professor of Applied Health Policy

This blog is reproduced from Marcus Longley’s column in the Western  Mail on 7 February 2011


September 9, 2010

Welsh Institue of Health and Social Care Blog
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» Trust me, I’m a cutter

Tuesday’s news that the NHS in Wales will need to cut more than £380m by April will have come as no real surprise to anyone. Commentators are beginning to run out of clichés and euphemisms for the process of making cutbacks, and the announcement of the findings of Comprehensive Spending Review on October 20th is focusing. The Spending Review is clearly the major political show in town, and has provided more column inches than any other single issue since the coalition came to power. Indeed it has provided the first significant dividing line in the Labour leadership contest – with different views on the speed of deficit reduction and the role of the state providing some clear water between the candidates.

Inevitably attention within the debate on cuts in health is drawn to hospitals and keeping people out of them – but this is just as much about community services in both health and social care. Whatever the focus, in order to achieve the level of cutbacks that are being proposed, politicians and other decision makers are going to impact heavily on local people who will be feeling the pinch most acutely – either because their service has been cut and/or because they have been directly affected as their job is threatened. With such high levels of public sector employment in Wales this double hit is clearly something those charged with implementing the cuts are trying to avoid.

A few brave souls are still talking about these deficit reduction measures in terms of an opportunity to re-shape and re-design for the better, but these voices are being drowned out by the deep and legitimate concerns of communities that their services are under threat and may be lost.

All of this is very familiar, so why post a blog on what we already know? Well, for me, what has been surprisingly missing from debates so far have been questions about how major changes would be made if the threat of financial meltdown was not hanging over our heads. In an ideal world, any such major reconfiguration of services would be justified by providing clear evidence that doing things differently will improve outcomes for service users and patients. Full stop. If that could save money, then great, but that would not be the primary driver. Achieving such change would require fundamental questions to be asked about what, when, how and even why services are provided. But equally fundamentally are a series of questions about the nature of the relationship between us and those that provide services which would need to be considered. This would lead to a different type of partnership – one based on mutual respect and a re-balancing of power – between patients, service users, their families and the professionals that care for them. This partnership is essential to developing new relationships connecting citizens with their health and social care organisations so that they use them differently in the future.

Now, that’s a rather naïve position to take, you might think, given the financial realpolitik of our current situation. But let’s just for a moment move away from all of the clamouring voices and consider how services might look five years from now.

Services will still be severely financially constrained and providing on a more limited basis than now. In all likelihood fewer people will be working in the health and social care sector. The nature of the patients and service users they see may be different given that higher thresholds for receiving treatment or care may well be operating. There may well be fewer buildings from which services are provided and more delivered in community settings. But people will still need treatment and will still need caring for. And if we do not seize the opportunity to re-design the nature of the relationship at the individual level then, to use a well-worn and hackneyed phrase, the crisis will have been well and truly wasted.

Written by Dr Mark Llewellyn, Senior Fellow