Health Chat 50

“So, what is a Health Economist doing in a place like is?”.  Being chatted to by Roy Lilley of course, at The Kings Fund in London, at one of the NHS managers.net. This was a landmark occasion – the 50th Health Chat. I was there for the first, and the majority in-between. And always, always have been uplifted and learnt something.

Roy & Anita Charlesowrth

Anita Charlesworth with Roy Lilley

The willing interviewee was Anita Charlesworth, Director of Research and Economics at the Health Foundation.  She is also Honorary Professor in the College of Social Sciences at the Health Service Management Centre at The University of Birmingham

Interesting Roy alluded to the first ever interviewee, Dame Ruth Carnall. He linked the fact that the 50th interviewee was another woman in a senior NHS role.  As Anita pointed out, the fact remains we are still less at than 3% of senior positions held by females.

She did hanker after going back to berate her Careers Advice teacher.  There are more possibilities  than becoming a nurse or a teacher (with nothing against those prospects, but she is right, there is more that is possible).  It just that no one told you that back then…

Gosh, it was a free ranging discussion.  We started with how and why Health Economics was her calling.  As ever, serendipity and an influential inspirational boss were the enzymes. It was the Masters in Health Economics at York that got her started.) (all the degrees, even chemistry and physics, used to be BAs at York.  I play am still rather upset that all economics degrees are BAs and MAs.  Why can’t it be a science?)

But what do Health Economists do?  Anita’s Masters dissertation gives you some idea of the questions they try to answer.  “Should every woman be screened for Breast Cancer?”  The attempt is to have science and numbers answer those sorts of question, not passion or opinion.  I suppose that sums up the raison d’etre, really?

Let’s get some of the quotes:

“We often focus on what you can measure”  (Sadly, what gets measured gets done – even if it is only measured because it is easy to do so…)

“Show me the evidence”

“If you were good, anywhere in the senior civil service, Treasury stole you”

I got the feeling that no one is leading the NHS.  No one is looking at the whole piece – old style DHSS.  Health and Social Care together.  Surely my cynical alarm can’t think the government might have sectioned off social care and community services to save money and screw up local authority budgets (so they get blamed rather than the government)? And maybe, hyper-cynically, to make the NHS wither on the vine?

I did want answers from Anita.  I wanted my cynicism to be assuaged.  I got a list of priorities, that were evidence based.

What were her priority concerns? (I liked them).

  1. New government 2015 decisions were worse than 2010 coalition.
  2. Austerity is proven not to be a good way to fix funding shortfalls
  3. We might need Keynes mentality, not Cameron / Osborne austerity continuation
  4. Investing in people’s health is worthwhile – Public Health, not Sickness is cheaper, but needs investment
  5. Tax funded health service, free at the point of use, is sustainable
  6. The model is fundamentally right
  7. Anita worried about the next few years – especially the potential for staff leaving who just throw in the towel, because they are undervalued and not engaged
  8. We might need to invest first before we gain….sorry, we need to do this, not might.
  9. It’s not worth doing investment in one specific area which might give a positive sound-bite…like more consultants…if they have no nurses to support their work. No one thinks of the whole piece

There are amazing and effective new models of care out there, and need to be out there:

  1. Sam Everington from Tower Hamlets (a previous interviewee, and very enlightening), where 93% of first contacts in NHS happen in GP land, for only 11% of the budget. It is a bargain.  And works. (Click here for more)
  2. Primary Care Home works well in areas it is being trialed (see NHS England summary here)
  3. Buurtzorg could easily be adapted to our UK funding model, and nurses would love it, and so would patients and their families. Let’s not forget that.  And suddenly, we don’t have as much delay in transfer of care.    And powerfully. (See founder Jos de Blok presentation to Kings Fund

OK everyone – you may have noticed at health chat 50 I have been more self-opinionated than normal.  But the whole NHS and Social Care arena feels like it is under attack, and that attack is not going away.  And that is not for the want of all the totally committed people who keep it rocking and rolling.  The staff.  The poor overworked and under resourced stalwarts, who get abused from all sides, and hopefully never read The Daily Mail.  Let the good people and their managers and leaders get on with it – they can keep it going.  Let’s just get the politicians out of the way. Except to sign the cheques.  And maybe agree and set some boundaries.

(Thanks to Roy Lilley – and here’s to number 100!)

(If you want to see the whole interview – it is available here )

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