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Change in a cold climate

6th October 2006

06102006_Coloured_Signs.jpgChange in a Cold Climate.  If you do what you always did, you will get what you always got.  It occurs to me that this is no longer an option for 21st century healthcare.

The current discussion and direction of travel that the traditional healthcare delivery settings are under review is newsworthy. Change is here.  It is inevitable.  It poses challenges.  The old adage, to begin with the end in mind is wise counsel.  A shared definition of what change management initiatives may mean in practice is important to establish at the outset to support the overall delivery. In any change programme, large or small, the trajectory of change, however “well managedâ€? may still produce unintended consequences.  As change is rarely linear, such additional synergistic outcomes may also be positive and add another dimension that could not have been predicted at the outset. 

To relocate services in community settings will require not only logistical planning, and new ways of working for example, but also a new concept of what it will mean to be the patient in this brave new world. Health literacy, which will help accomplish the aim, is a hot topic.  It needs to be.  Health literacy, like change, is a broad spectrum term which covers anything from literacy in the classical sense; to debunking urban myths about illnesses, unpicking psychobabble, and importantly, upskilling lay service users to ask questions.  This range does not undermine its potency towards impacting on the delivery of the overall vision of plurality of services, closer to home still under an NHS umbrella.  Traditional care settings will change, and a patient’s ability to navigate the system will be key to grounding the suggested vision.
 
Health literacy in its broadest sense aims to:
• enhance patient safety,
• improve outcomes
• promote efficient care
• reduce costs

To deliver the new style of care being proposed under current secondary care reviews, health literacy becomes central to that cause.  Traditionally, the patient entered the healthcare domain and relinquished control and expertise to the professional carers.  To further emphasise this dependency other rituals were employed, the outside world reality was suspended, and families became visitors to this high-tech liminal cyber world.  Like the Wizard of Oz, the smoke and mirrors of expert providers may have kept questions at bay, knowledge in-house and waiting lists long.

Then, someone showed some initiative, or rather showed us as professional providers some initiatives that had to be met.  The wizard, uncovered, had to admit patients may be able to self-care, self-medicate and self- actualize out-with a hospital setting.  No, actually, the last point really was seen as just fantasy for quite some time.

As the health service moves from an historic command to market economy status, health literacy for all – purchasers, providers and patients – is emerging as a new and potent currency.  It will be pivotal in delivering the new health care agenda in multiple settings, across organisational boundaries and to cost; which will only be achieved by co-creating care with informed consumers.  This would suggest that the healthcare capital in economic terms is more than the annual budget allocation / spend dynamic.  Health capital may be understood in as much as the real value of a healthy population may be defined in the provision of monies to provide care for the sick.

Do healthy people have value in this market?  Historically, perhaps not.  Little NHS overall spend has been targeted at health promotion and healthy lifestyle.  The majority of the budget has been utilised to provide a secondary care led provider service; which as been necessarily expensive, if reactive. The NHS has been busy dealing with the bodies drowning in the river; it has now turned its attention to upstream, to see who’s throwing the bodies in.  Metaphorically, this can be understood at the individual and collective level, quantum indeed.


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