Leading healthcare professor Don Berwick says NHS could be world number one if it integrates care
One of the world’s leading healthcare experts says the NHS will be the best system in the world if it succeeds in integrating care, getting people and organisations to work together.
Professor Don Berwick, a former adviser to Barack Obama, says the NHS is teeming with people who have built modern services fit for the 21st century and it would be smart to learn from them while creating the future NHS.
He said the fragmented nature of the NHS could be solved if all local health and care organisations, including local government with social care, worked in partnership and pooled resources, a movement which is underway.
Prof Berwick said: “I think the NHS probably has a better chance to truly integrate care than almost any other health care system in the world.
“We’re not our diseases, we’re not a broken arm or diabetes we’re whole people who are making journeys through our lives and the care system has to honour and respect that.”
Prof Berwick is now an advisor to the King’s Fund think tank and a leading authority on health care quality and improvement. He has served on the faculties of the Harvard Medical School and Harvard School of Public Health as well as leading the US federal agency overseeing Medicare and Medicaid.
A paediatrician by background, he was for 19 years the founding CEO of the Institute for Healthcare Improvement and is now a senior fellow.
He said the new care models programme had generated a faculty of knowledgeable clinicians, managers, nurses and doctors who could become teachers to the country.
“If you’re wise enough to tap into these lessons that are distributed all over the country you can put together models that are really based on experience,” said Prof Berwick in a film released today by NHS England.
People are living ten years longer on average than when the NHS formed 70 years ago.
There are half a million more people over 75 than in 2010 and there will be two million more in ten years’ time with these people spending more years in ill-health.
Between 2015 and 2035, the numbers of older people with four or more diseases will double and a third of these will have mental ill health.
But Prof Berwick said improving health through social determinants like housing and lifestyle was another key to success.
“There’s no reason the NHS can’t have the best care in the world, why you can’t take an appropriate proportion of your efforts and move them upstream to the causes of illness and use social determinants to prevent illness. There’s no reason why you have to waste money; you have limited resources and you can use those resources increasingly wisely.”
Incurable long-term conditions now account for half of all GP appointments, almost two thirds of outpatient appointments and seven out of ten inpatient bed days.
Tackling multiple and long-term conditions is overwhelmingly the main business of the NHS, not the exception, with £7 out of every £10 spent on them.
65 per cent of people admitted to hospital are over 65 and a person over 80 who spends 10 days in hospital loses 10 per cent of muscle mass – equivalent to 10 years of ageing.
In response, we need a system that supports an individual’s complete needs – rather than treating each body part, illness, or care problems in isolation.
That’s why over the next few weeks the first parts of the country formally begin to work as integrated care systems, a key milestone as England makes the biggest national move to integrate care of any major western country.
For example in the Frimley system, in Surrey, joined up care is well underway.
Single multi-disciplinary care teams – comprising GPs, nurses, mental health, social care, therapists – are being created that are helping people avoid crises and stem rising emergency hospital admissions for the first time in years.
They ensure all care is delivered smoothly and people tell their story once. Where people do arrive at A&E, the doctors there get help to find solutions for complex situations that prevent unnecessary hospital stays.
Prof Berwick said it was essential to find time amongst many pressures to build relationships otherwise success would be elusive.
“Right now the NHS is under enormous pressure. You’re going to have to find the time.”
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