More money or a new model of care is not always the solution to everything.
Over the past 20 years community nursing has been through a huge amount of change. But as our historic PCTs potentially move into PCNs, there is a sense of having been here before with primary and community care being brought together.
Will the new model really drive improvements for patients that will allow our nurses and doctors to do what they trained to do, deliver care?
From a quality perspective we should expect the outcomes to improve, especially with the additional funding being levelled at the problem but as any healthcare finance professional will ask you, can I count it? Now that’s not a cold cynical question to a subject as emotive as healthcare, it insists that we’re getting the right results.
Sure, we’ll have more time to care, an essential part of the patient experience, and we won’t levy further pressure on nurses and doctors and, should we ask any patient what their experience was that day, we can record their response. But where is the quality measure for those we couldn’t see as the time was not spent in direct clinical care? The previous Lord Carter review of community and mental health services identified that only 1/3 of clinical time was patient facing, and from my experience that hasn’t changed much in 25 years. Should you ask any community nurse what they’d like it to be, and I have asked many, the answer will almost always be somewhat north of that.
The sweet balance of efficiency and quality comes from those outcomes, measured. So, if we put more money into the system, should we expect the outcomes to improve? I’ll risk a contentious answer here. No, we shouldn’t. Not unless we’re funding innovative technologies that help deliver care more efficiently. Not unless we’re also setting an expectation of a ‘fair day’s work’ and managing it to ensure that we’re delivering the best possible outcomes we can, from the resources that we value.
But if we’re suggesting that more money in resource would automatically deliver better outcomes, we’re kidding ourselves on.
Unless we agree a baseline that considers the local challenges, that being an agreed expectation of activity volumes, we’ll be throwing problems at the money, as well as money at the problem. For when the additional funding stops, we’ll be back to wondering how we survive without it.
We have to be absolutely clear on what the problems are, quantify them, and be sure that before we make any proposed changes to models of care or release more funding, we are satisfied with what we’re currently paying for.