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European Care, 2016: Wales and The Final Countdown
I’ve written extensively over the past month about health and social care in Europe, looking at the challenges posed particularly by the aging demographic profile and increased morbidity especially in very old age. I have also profiled best practice from the UK, Ireland, and Spain where it is relevant to the experience of care provision in Wales.
WHO and European Health Strategy
To round off this series I wanted to take a moment to look at the 'strategic' direction that Europe is moving in via the Health 2020 initiative and consider the reference points for Wales. This task seems all the more worthwhile given that we are counting down to the 23rd June referendum to decide our future within the EU.
Now 'strategy' is a word which is used a lot in both the world of business and the public sector – but not always meaningfully or convincingly. Plans which chop and change or alter to accommodate fads and fashions are not strategic, more opportunistic. Strategic planning takes into account more extended planning cycles than say 12 months or 2 years.
In the public sector, strategic planning adopts a 10 year + perspective, identifying the long term goals and objectives within which detailed blueprints and implementation plans can be realised. And so it is in the field of health. The World Health Organisation with its unrivalled global view and international data and research capability are pre-eminent in defining international health policy. Strategic objectives are cascaded down to continental and national level for supra-national organisations (like the EU) and national governments to design their own plans, whilst adopting the goals and objectives of WHO strategy. Primary care, citizen-participation and early intervention has been central to WHO policy for at least 30 years and this direction is still being pursued and is reflected within the EU's current strategy which is called Health 2020, and its various subsidiaries, which we can now review in brief.
The two strategic objectives of Health 2020 are:
- Improving health for all and reducing health inequalities;
- Improving leadership and participatory governance for health.
Health 2020 is based on the values enshrined in the WHO Constitution considering health as a human right and seeks to improve health and reduce inequities.
Health is regarded as a key to unlocking human potential individually and collectively as a society. Poor health wastes potential, causes despair and drains resources across all sectors of society.
The policy framework presents ways in which policy-makers can more effectively and efficiently address today’s social, demographic, epidemiological and financial challenges, by resetting priorities, catalyzing action in other sectors, and adopting new approaches to organizing the health sector with other stakeholders.
2020 seeks to bring governmental agencies together to achieve better and more equitable health and well-being. It recognises that health is the responsibility of the whole of society with its many stakeholders, and the whole of government.
The policy framework suggests new ways to identify important health gaps and focus individual and collective efforts on ways to reduce them. It shows how progress has been most successful in countries that provide affordable care and social safety nets through strong public services and sustainable public finances.
Health 2020 builds on the experiences gained from previous health for all policies and is supported by a wealth of evidence gathered in both traditional and emerging health policy areas.
Together for Health is the Welsh Government's five year vision for the NHS which sits within the 2020 strategic direction and is commited to the delivery of services best suited to Wales and comparable to the best anywhere.
It is based around community services with patients at the centre, and places prevention, quality and transparency at the heart of healthcare. The Together for Health document also outlines the challenges facing the health service and the actions necessary to ensure it is capable of world-class performance.
Informed by the work of the Bevan Commission and others around the world, the NHS in Wales is taking on the principles of prudent healthcare as it responds to these challenges. Prudent healthcare puts NHS Wales at the front of a growing international effort to get greater value from healthcare systems for patients.
Principles of prudent healthcare
Any service or individual providing a service should:
- Achieve health and wellbeing with the public, patients and professionals as equal partners through co-production;
- Care for those with the greatest health need first, making the most effective use of all skills and resources;
- Do only what is needed, no more, no less; and do no harm;
- Reduce inappropriate variation using evidence based practices consistently and transparently.
Social Services and Wellbeing Act
It is no mistake that these principles are also exemplified in The Social Services and Wellbeing Act (2014). Strategies are, after all, thematically cross cutting and require multiple programmes of statute, policy and spending to be dove-tailed.
The NHS in Wales is facing the twin challenges of rising costs and increasing demand, while continuing to improve the quality of care. In Wales as elsewhere in Europe, budgets are under pressure, to the extent that the whole funding model is called into question. The old district general hospitals seem to be either being developed as regional hubs for acute and specialist services or regraded to non consultant led and outpatient services.
Meanwhile new ways are being sought to make sure the health budget goes further. Technology has a clear role to play here, perhaps through remote consultation utilising the internet and digital technology, or developments in life-science and clinical research. Some of the big health gains are likely to come through public health initiatives encouraging exercise, smoking cessation, reduced alcohol intake, weight management and stress reduction.
In Wales there has been clearer acknowledgement than in England that the budgets for health and social care are intrinsically linked and need to be balanced responsibly against each other. If we reduce the social care bill we may find it difficult to accommodate people being discharged from hospital (England). If we protect social care funding we may find that waiting times go up (Wales). We will need as a nation to enter into mature discussion about these matters to decide priorities for the years to come.
For now the benefit of sticking to a strategic plan is that as we emerge in Wales from a secondary care focussed health model, to one more immediately relevant for each individual, we have a clear sense of values and direction moving forward.