So what’s different this time? We are in a period of sustained reduction in funding for the NHS. While in the past NHS chiefs were able brush the need for change under the carpet, they now have to face these difficult decisions head on. Simply put, we can’t afford the current model of care without reducing the quality of it. An easy sell you would think…

So why is there so much opposition to changing services and moving care away from local acute hospitals?

Change is always difficult; we are averse to it in many areas of life. People are worried when they see their local hospital remove key services, meaning they need to travel an extra 30 minutes to receive care. For many this equates to getting a poorer level of care from their beloved NHS.

This level of fear and disagreement is stoked by local politicians backing campaigns to save services. This can be seen as a shrewd political move to gain more votes, but doesn’t help the national direction on the NHS – an issue that is discussed at length in The Guardian today (25 January 2013).

At the same time many local clinicians are joining campaigners in marches across the country, unhappy with the reasoning behind these reconfigurations and questioning the clinical effectiveness of such moves. This makes it very difficult for NHS chiefs to promote the benefits of change and for the public to understand them.

Communications and engagement before, during and after service redesign and reconfiguration are integral to ensuring they work. This is a big part of the problem. As someone who has worked within the NHS, I know how consultation can sometimes be viewed. It is a tick box. Something that is done after decisions are made to make sure the public has had an opportunity to ‘comment’, a legal requirement with no substance.

Don’t get me wrong, I am aware of good examples across the country where this isn’t the case and guess what the outcomes are? A more involved and engaged local population who believe in the changes, or at least understand the reasoning behind them.

Effective communication and engagement strategy and planning, as an integral part of the service redesign/reconfiguration process, is the first step to making the public accept the need for local hospital reconfiguration.

Involving the public in the development phase of redesign and reconfiguring services is a great way of getting innovative solutions to long term problems.

Being honest about the reasoning behind the changes and being clear about the issues that will occur if services stay the same is vital. It means that the views you receive back are informed comments that will, in the majority of cases, improve your decisions.

It is unlikely that people will ever agree with their local hospital being stripped of services, but it is about time the NHS supported them to understand why it is for the greater good. With at least 17 hospital reconfigurations potentially happening over the next year only time will tell.

What are your thoughts? Is your local hospital looking to reconfigure services and do you believe in the changes? We would love to hear from you…

If you would like advice or support on delivering service redesign consultation effectively, please get in touch.

The new commissioning structure will, and already is, starting to have a significant impact on the way decision making in the NHS is tackled. While an understanding of how the proposed commissioning boards at a national and regional level will work in reality is still limited, at a local level, through Clinical Commissioning Groups (CCGs), the picture is much clearer.

CCGs, although in shadow form, are already starting to flex their muscles. They are looking to tighten up contracts with healthcare providers to ensure they are getting better value for money and services that are delivered how they want them to be.

With responsibility for the majority of the NHS budget, GPs now find themselves with even more power. Many will find themselves in the enviable position of having the money to commission health services and the ability to provide them.

This new commissioning role will create opportunities for pharma and now is the time to start building relationships with CCG leads as they will be looking to shape how healthcare looks in their locality. With over 200 CCGs th e task is huge and careful planning is needed.

This is only the first step in building stronger relationships with the NHS. As the roles and responsibilities of the national and regional commissioning boards become clearer, so will the next actions needed by pharma.

Grant joined Aurora to support Clinical Commissioning Groups and Commissioning Support Services during service redesign to engage and consult the right people using new techniques including digital media. He will also be offering issues management advice during an increased time of change. He has experience of working in communications and engagement within the NHS at a strategic, commissioning and provider level.

If you would like to know how pharma can be involved in joint planning with the NHS, please get in touch on 0207 148 0442 or email grant@auroracomms.com

On the other side of the ‘pond’, bigger political reforms are taking place. On the healthcare front, many hope that Barack Obama’s new term in office will bring about better healthcare accessibility to a wider population. ‘Obamacare’ or the Health Care for America plan aims to change the current healthcare system that is mostly controlled by private insurers, to extending healthcare access to all Americans. As of 2010, 16% of the US population (49.9 million people) were without health insurance, and they would simply go without medical treatment, unless a charity or uncompensated care can pay for it. To put it into UK context, this is proportionately equivalent to the population of Northern Ireland, Scotland and Wales not having access to healthcare. At the moment, only 28% of Americans have access to healthcare under government programmes, this generally includes the elderly, disabled, children, veterans, and those deemed below an income threshold. And there are only a handful of American states that have adopted the universal healthcare system (with the state of Vermont being the only one that has established a UK-like single-payer system), however the hope is that the new healthcare reform will ensure better access to healthcare for all, whether insured or not.

It is interesting to see the different healthcare systems of the UK and US, and comparing them to what I have back home in Malaysia. Just as the UK, Malaysia adopts a two-tier public-private healthcare system; all citizens have access to public healthcare, while private healthcare co-exists and is available to those who can afford it. Where we differ is the gap between the two: private healthcare in Malaysia offers fast and higher quality of care with the aid of more advanced tools, while public services face a significant shortage of facilities and expertise. I am looking forward to see the transition of the American healthcare system, and perhaps this could provide some key learnings for the Malaysian system.

We are witnessing a major change in the US, and the UK is still in the midst of it. Perhaps we should all look at France, the country with the best performing healthcare system in the world, as rated by the World Health Organization, and learn a thing or two from them. Factors that put them at the number one spot are: relatively low expenditure, high patient success rates and low mortality rates, and high consumer satisfaction.

It would be interesting to see in the coming years how the healthcare reform in the US unfolds, and if the proven universal healthcare system will improve the wellbeing of the American population, or financially limit the government. In the UK, whatever you think of Mr Hunt and the NHS reforms, we should consider ourselves fortunate to be able to benefit from high quality healthcare that is available to everyone. After all if the most powerful country in the world is looking at us with a view to implementing a similar system – we can’t be doing too badly.

Aurora believes it is important to be adaptable in this globalised world, as different markets have different needs. How well your brand can work across markets largely depends on the working relationships that you have. We are part of a global network of healthcare communications experts, speak to us today and let us help you tackle your challenges.

Want to find out more? Please click on the hyperlinks throughout the blog and the suggested reading below:

Healthcare System in France – Healthcare in France, Wikipedia

Healthcare System in Malaysia – Healthcare in Malaysia, Wikipedia

Healthcare system in the United Kingdom – Healthcare in the UK, Wikipedia

Healthcare system in the United States – Healthcare in the US, Wikipedia

Healthcare for America – Information on President Obama’s healthcare reforms plan

World Health Organization: The world health report 2000 – A report on health system worldwide by WHO

There was an expectation at the time that we would hear his views on what was/is seen as the most controversial of government policies and the biggest change to the NHS since its inception. Radio silence ensued and a topic that had been in Aurora’s monthly top 20 healthcare media issues for months is now under the radar.

We had to wait until the Tory conference before we had the chance to hear any sort of view from Jeremy Hunt. With over a month of silence we were hoping for clarity about his views on the biggest re-organisation in NHS history. What we got was his views on the time limits for abortions – a view that overshadowed the first two days of the conference. The next topic, views on homeopathy, an area that is normally given a wide berth by senior politicians.

And if that wasn’t enough he then spent most of his conference speech talking about integration – baffling everyone at the conference – the majority asking the question isn’t this restructure about disintegration?

Since then he has rarely talked about the reform, choosing to talk about doctors’ appraisal processes, the South London Healthcare saga and recently the launch of a review of the decision to close some children’s heart surgery centres. All important issues but they don’t address the elephant in the room.  Why? Is he still figuring out how to implement something that is already full steam ahead? Is he happy with the changes and just getting on with it?

Michael Portilo spoke recently at the National Association of Primary Care Conference, which I attended. He was quite clear about why Mr Hunt has been appointed – he is a ‘doer’ not a thinker. His role is to push the reforms through as smoothly and quickly as possible. By keeping quiet on the reforms and diverting attention to other issues he is able to get on with reform work in the background.

That is all good and well but I imagine many professional bodies, trade unions and the general public would like to see a bit more transparency and get an understanding of what Mr Hunt is actually doing while the greatest NHS change in history takes place. Only time will tell, but we’d love to hear more about it. Are these diversion tactics well thought out or could they spell PR disaster?

There has been a lot of speculation in the past 48 hours about the role Mr Hunt might play – would he stay as Culture Secretary or would he be one of the first to go? However, as reported by The Independent, it appears he has been promoted. In an interview with the BBC outside No 10, Mr Hunt said he was “incredibly honoured” to take over health and “it is a huge task and the biggest privilege of my life.” Mr Cameron is now entrusting another MP to deliver the NHS reforms, a huge responsibility, but why do it now after such a long, hard fought battle to get the Health and Social Care Act passed? Does Mr Hunt agree with the reforms as they stand or will he be making his own alterations? How does Mr Lansley feel about all this? Our understanding is that he worked very hard behind the scenes before the Government came into power to put together his plans for reform, but now he will not have the opportunity to deliver them. Instead he will simply be a spectator in his new role as Leader of the House, which some have called a demotion.

At Aurora, we will be very interested to hear the response and comments from the NHS and healthcare community in light of this news. What does Dr Clare Gerada, Chair of the Royal College of General Practitioners and outspoken critic of the reforms, make of all this? No doubt they are crafting their careful responses at this moment – will they welcome this change or do they foresee even more turbulent times for the NHS? Can the embattled NHS survive anymore shake ups?

These are interesting times in the world of UK healthcare delivery and there are so many more questions to be answered, with potentially tremendous impact. A lot more will be revealed in the coming days and weeks, and Aurora will be keeping a very close eye on the proceedings and how this could impact our clients, and healthcare communications more broadly.

The overall word cloud for the tweet stream has not changed much from last year and is clearly dominated, unsurprisingly, by the #doctors20 hashtag.

However when you remove the conference hashtag and time and date stamps you can see that in 2012 the retweet rate was huge at 980, almost three times as many as last year. However this year there was almost no mention of other twitter groups such as #hcsmeu or #hcsmES which both featured fairly heavily last year. This year saw more people active on the tweet stream with many more twitter handles featuring strongly in the feed.

The next step was to remove common English and French words, e.g. the, le, des and twitter handles to reveal the topics we were discussing on twitter this year at Doctors 2.0 and You. Day two started with a series of moving presentations from patients around the world and this patient focus carried on throughout the twitter stream with 646 mentions of patients across the two days. I was also interested to see how ‘social’ seems to be a dying word as it features less prominently in the word cloud.

I was delighted to meet some of the patients attending the conference and the word cloud above is testament to the great job they do everyday so a big shout out to:

@Kgapo (Kathi Apostolidis) from Greece a two-time breast cancer survivor and e-patient advocate who tweets regularly and blogs in Greek.

@AfternoonNapper (Sarah Kucharski) from the USA, an intimal fibromuscular dysplasia patient who is a co-founder of FMD Chat (@FMDChat) connecting patients around the world.

@Renalooo (Yvanie Caille) a French kidney patient who set up Renaloo.com in 2002 to support French kidney patients and their relatives.

@ForumThyroide (Beates Bartes) Beates set up one of the first French patient communities online Vivre Sans Thyroide which offers information and support to patients with thyroid-associated illnesses.

I had a great conference, discovered that I can tweet just as quickly from the iPad as a laptop without the battery issues but most importantly I met old friends and new (see twitter pics below) and spent two days talking about how digital can make a difference in healthcare, more on that to come in later posts.

]]> http://www.auroracommsblog.com/doctors-2-0-and-you-2012-in-word-clouds/feed/ 5 http://www.auroracommsblog.com/the-ccg-countdown-one-year-to-go/ http://www.auroracommsblog.com/the-ccg-countdown-one-year-to-go/#comments Mon, 19 Mar 2012 17:37:22 +0000 chiantichiara http://www.auroracommsblog.com/?p=3162 If the government’s Health and Social Care Bill is to go ahead, this time next year, Clinical Commissioning Groups (CCGs) around the country will be preparing to ‘go live’. Set to replace the current Primary Care Trusts (PCTs) and powered by GPs, CCGs will commission local health services and will take control of 60% of the NHS budget, which equates to £60billion.

The Health and Social Care Bill is without doubt the biggest shake-up in the NHS since it was founded in the 1940s. As the Bill is pushed through its third reading in Parliament today, the public and NHS staff need to ready themselves for the forthcoming reforms. Change is on its way. David Cameron has pledged his full support to Andrew Lansley, and in his key note address at the recent Liberal Democrat spring conference, Nick Clegg said it is a better Bill because of the Liberal Democrats and called on his peers to support it.

Despite all this political rhetoric, perhaps the clearest signal yet that the Bill will imminently become a reality is the Royal College of General Practitioners (RCGPs) sudden change in stance. A vehement opponent of the Bill, only last month the RCGP were calling for the Bill to be scrapped, however last week they were willing to reopen talks with the Government, in the spirit of collaboration and pragmatism, on how best to implement GP commissioning on the ground – a sentiment echoed by Royal College of Physicians. Perhaps they both had a premonition about the outcome of today’s third Parliamentary reading and decided that an ‘if we can’t beat them, join them’ approach is the best for all concerned.

Since the unveiling of the Bill by the Coalition in January 2011, its passage through Parliament has been far from smooth. Despite its stuttering progress, the final ‘go live’ date for CCGs has always remained the same – April 2013. It is clear to everyone that there is a lot of work still to do in a short space of time. According to Dr Foster’s Intelligent Board, CCGs will be successful if they focus on four key tasks;

• Becoming an organisation for the people
• Building relationships and partnerships within a wider health network
• Ensuring quality and safety, effective patient engagement and the promotion of innovation, productivity and integration
• Creating new relationships with providers of care.

Interestingly, a recent article in The Guardian claimed that in some CCGs, GPs are each spending up to two days a week away from practices, raising concerns that GPs are too busy with commissioning to see patients. This is not a new argument and was raised during last month’s PharmaTimes Great Oxford Debate, which posed the question “Commissioners don’t have the patient’s best interest at heart”. One of the proposers of the motion, Lord Philip Hunt ventured that because GPs don’t have the requisite skills to commission not only will they will have to invest a lot of time in learning how to do so, but it will also create a conflict of interest for the GP and the bonds of trust that exist between patient and family doctor will be irreparably broken.

In a rebuttal to The Guardian article, NHS Alliance chairman and Devon GP Dr Mike Dixon said, ‘A lot of work that GPs do after seeing patients is around developing services based around patient care. We commission care. This is what we do.”

It is clear that this Bill is still igniting passions on both sides, and probably will continue to do so long after it’s passed by law, which I think that all parties will agree is almost upon us.

Sparking interesting and lively discussion, one of the Aurora staff was lucky enough to have been present at the PharmaTimes Great Oxford Debate. To find out what was said and hear our thoughts, keep an eye on this blog!

I was therefore not surprised when the second phase of the listening exercise was announced at the end of last week to a muted media response. This phase, again chaired by Professor Steve Field and led by the NHS Future Forum, will be looking at four central themes:
1.    Information: how information can be made to improve health, care and wellbeing
2.    Education and training: how to develop the healthcare workforce to deliver world-class healthcare
3.    Integrated care: how to ensure the Government’s modernisation programme leads to better integration of services around people’s needs
4.    The public’s health: how to ensure the public’s health remains at the heart of the NHS

Professor Field himself said, ‘‘If we want the health and care system to change and meet the challenges of the future, then it is essential that we make sure that the thoughts and concerns of clinicians and, importantly, patients and service users, are listened to.” I agree one hundred per cent, but I still wonder why it has taken so long for those in charge to realise this. There are countless examples in other industries where the end users are involved in the development and testing of a new product or idea. Asking a sample of prospective customers what they think of ‘it’ is routine practice, but why has this approach never been applied to healthcare before? From a patient perspective it could be a hangover from the old thinking that ‘doctor knows best’ or, from a political perspective, it could be that, until recently, the old system has just about coped and the ‘if it ain’t broke, don’t try to fix it’ mentality has held fast.

However, because of the enormous pressures our healthcare system is currently facing, change is now critical and I’m delighted to see that (finally) patients are at the centre of this and are being consulted. Patient involvement in decision making will also now extend beyond the personal ‘no decision about me, without me’ to a wider remit looking at the health and social care delivery within their localities. Earlier this month, Andrew Lansley launched a network of 75 local HealthWatch pathfinders as part of his NHS reforms. If all goes to plan, the scheme is set to go live in October 2012 and, to quote the DH, ‘will give a voice to local communities to help shape clinical commissioning groups plans for services’.

Despite what you saw during the riots, people do really care about their communities, as witnessed when all those good residents turned up with brooms and bin bags to help the clean-up operation. It’s only ever the small minority of individuals that cause the problems. I would be delighted if those that turned up en masse to sweep up the debris on Lavender Hill actively contributed to the delivery of healthcare within our area. We would be in a much better place.

Professor Steve Field, Chairman of the Future Forum, opened his findings by reminding the Government of the NHS’ constitution, the first sentence of which is, ‘The NHS belongs to the people.’ This sentiment is certainly echoed throughout the recommendations with a lot more accountability to the public i.e. increased transparency on how money is spent and why it is being spent. The mantra ‘no decision about me without me’ is core to every element of the system, and decisions about how local healthcare is delivered will be made by a multidisciplinary groups of healthcare professionals, the ‘clinical commissioning groups’, who understand the cumulative needs of the local population, rather than exclusively by primary care (GP commissioners).

I think the most interesting outcome of the listening exercise is the revised role that Monitor will play in the new NHS. Their remit has been scaled back and instead of promoting competition, they will support choice. I personally believe that a little bit of competition is a good thing. It keeps people on their toes, drives improvements and innovation, and safeguards against complacency. Most importantly, it engenders choice, which is central to the Forum’s recommendations. The door has not been closed on private healthcare providers partnering with the NHS, however they will have to offer integrated solutions that result in a win-win-win scenarios (for patients, for the NHS and for themselves) rather than simply looking at how to most easily increase their bottom line.

So when will all this come to be? The April 2013 deadline has been scrapped in favour of an ‘as and when you are ready’ approach. Part of me agrees with this. It needs to be done right, first time, and therefore cannot be rushed. If we’ve learnt one thing from this recent ‘pause’ it is that forcing matters does not result in positive outcomes. However, this approach will invariably result in some early adopters while other areas will lag behind. The new NHS Commissioning Board will be responsible for commissioning in those areas until the transfer of power takes place, but could this lead to an increased inequality in healthcare provision? A situation that is meant to be rectified within the new system.

Thanks to the listening exercise, the future of the NHS is looking a little rosier, but it is still all to play for. Even though the Future Forum’s recommendations were well received, the Health Bill still needs to be rewritten and passed through Parliament. The debate continues and we will be following it very closely with a great deal of interest.

The Pharmaceutical Research and Manufacturers of America (PhRMA) welcomed the bill stating that although not perfect, it was a step closer to providing Americans with access to free, good quality healthcare coverage and services. This view was echoed by President Obama who stated: “This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction.”

Pharmaceutical companies will now pay more in fees than originally proposed; the planned annual levy of $2.3 billion has been replaced with yearly fees, which will rise gradually to $4.2 billion in 2018, after which they will decline to a regular annual total of $2.8 billion.

However to counter that, a number of industry-opposed initiatives were dropped from the final bill. These include a requirement for government / industry price negotiations for the Medicare prescription drug programme, allowing consumers to buy re-imported prescription drugs from overseas and also a ban on ‘pay for delay’ deals between brand-name and generic drug companies.

An additional advantage for the industry is that by 2020 the bill will close the ‘doughnut hole’ coverage gap. The doughnut hole gap is when the programme stops paying a beneficiary’s prescription drug costs after they reach $2,830 in any single year and then starts to pay again when the person’s own expenses exceed $4,550. Pharmaceutical companies contribution to this will be around $3 billion annually over nine years, but they will retain many customers who, having reached the doughnut hole in the past had switched to generic versions of their brand-name drugs, reduced their medications or simply stopped taking them altogether.

President Obama could now sign the bill into law as early as Tuesday 23 March.

The issue of US healthcare reform has always been a thorny one. It has been widely reported that President Obama has struggled to articulate his vision for healthcare reform so this latest victory has been widely praised and taken as positive proof that change can happen.

The New York Times reported today that: “On this one, he is the President he was supposed to be, the President of change you really can believe in. Barack Obama hasn’t always been better than the opposition. This time he is.”