Sunday, 7 October 2012

Making a Meal of the NHS Reforms, and 50 Shades of Middle Class

For all kinds of reasons, a prominent feature of my life last week was eating in restaurants of various quality and enjoyment. My lucky escape was in not being able to go to the somewhat strangely named Live Bait restaurant. It was a night out with my other Head of School colleagues. That wasn’t a problem. It was the fact that the restaurant specialised in fish dishes of every hue and type. Being a vegetarian, sitting next to colleagues eating their way through various fish dishes absolutely didn’t appeal.

Interestingly, cafes featured in a very interesting piece written by Professor Paul Corrigan, Director of strategy and commissioning for the NHS London Strategic Health Authority and former Labour Party adviser, and his colleague, Dr Steve Laitner, GP and associate medical director of NHS East of England. In an intriguingly entitled report - The Accountable Provider: developing a powerful disruptive innovator to create integrated and accountable programmes of care.

This report looks at why many people talk very highly of their experience of NHS services when speaking about a specific experiences of treatment, yet  have problems with their overall experience of the NHS. So patients’ feedback starts with  patients saying that each doctor, nurse, pharmacist and ambulance driver was really good., and that each aspect of the care was really well delivered, but the overall experience was not good.

For example, patients complain about: being asked the same questions over and over again; about hanging about between bits of the service; about having many people involved in their health care but not really sure who is responsible for what and who is in overall charge of their care; and of not really knowing what is going on. So it seems that whilst the bits of NHS care are reported as being very good, the overall service is often poor. This is not a new problem, and many professionals working in the NHS have struggled with the problems caused by the changes to the organisation of care. Likewise there are few models of integrated care that have been systematically evaluated.

What Corrigan and Laitner argue for is a strong ‘integrator’ who has the power to make providers of care provide single pathways of care. In other industries very complex supply chains come together to provide a simple output for a customer. The example they use is that when we walk into a cafe and order a cup of tea you do so without worrying about having to go to India to buy a tea plantation in order to enjoy a good cup of tea. The logistics and supply chain management will have been already sorted – you just have to enjoy the cup of tea. This has to be a new and sustainable approach to commissioning care to both improve quality and productivity.

And quality and productivity were on my mind yesterday when my eldest daughter and family joined my youngest son and partner, who having just moved into their first house together wanted to celebrate. So we went to the Mud Crab Cafe in Didsbury to have a celebratory meal. Not sure it would have been my first choice, but there you are. There were 7 of us, which was the first problem, but eventually we were all seated. Then it was down to selecting a meal. Mine was a cauliflower cheese finished off with truffle oil – however it was the accompaniments that caused the biggest problem and drew the largest laugh.

The French Fries came dressed with something called Chicken Salt. Being a vegetarian this was of concern. Not to worry. The French Fries seasoning was billed as coming from the USA, although it was actually manufactured in Australia and was completely meat and fish free. Corrigan and Laitner would have been impressed with the seamless supply chain that delivered such divine chips.

Finally, totally fed up to find I am no longer a possible member of the middle classes. The Times, yesterday presented the 50 attributes of being middle class. I failed the test. I don’t do Man Hugs, and my dog is called Cello because it suits him not because I ever wanted call one of my children Cello, I don’t drink water, tapped or bottled, either at home or in restaurants, never entertained the notion of having a trampoline, I do have a tattoo, but it’s a picture of a chicken so that probably doesn’t count, and making cheese, well I was making cheese 37 years ago, not because it might be a fun thing to do, but because it fed the family, and camper vans are for those who have never stayed in a 5 star hotel. 50 Shades of Middle Class indeed!