Monday, 2 November 2015

La Liberté d’Imaginer: La Nécessité d’agir


I used to worry that what I write today might be at odds with what I wrote six or 12 months ago; now I worry that what I write today might not be at odds with what I wrote six or 12 months ago. The point being that the world moves on, and the world of healthcare quality and safety moves on with it…or even faster. I also think that we all have a prerogative, perhaps even a responsibility, to change our minds, to shift our positions. In politics, if it were not for the so called ‘’swinging voters’’ there would never be changes of government and we would all be the worse for that.

So, after I finish this BLOG I do not propose to check that my thoughts today align with my thoughts of yesterday.

Hence my theme.

China’s President recently visited Great Britain and much fuss was made of the visit. In his address to a joint sitting of the Commons and the Lords, President, Xi Jinping, quoted Shakespeare, specifically The Tempest Act II Scene 1 in which Antonio is trying to persuade Sebastien to kill his father the King so Sebastien can be crowned……. ‘What’s past is prologue’, he says to the impressionable Sebastien, his point being that what has gone before creates an inevitability about what we must now do………all that has gone before is just preparation for what must be a different future.

While we might not like what Antonio was up to, his rationale is ‘right on’ when it comes to healthcare and the future we face.

If we just ‘keep on keeping on’ in healthcare we will:
  • Run out of money
  • Age unhealthily
  • Have to make frightening choices as a society and as individuals about who we treat and who we do not. For instance, it may be that a child born today will only live past 70 if he/she remains well, we may choose to treat only the so called ‘productive members of society’ with our limited resources rather than those not creating wealth.
  • Fail to apply the latest treatments and technologies.
  • Miss the whole point of the patient journey and patient centered care.
  • Continue to try and make sick people, usually acutely sick people, well instead of stopping them getting sick in the first place.
Rather than go on, let me summarise the paradigm shift that is necessary if we are going to have any hope of making healthcare delivery possible in the future and of continuing to deliver safe, affordable quality care.

Frost & Sullivan

Or as Professor Angela Brand, Coordinator of the Public Health Genomics European Network (PHGEN) at the University of Maastricht and Director of the European Center for Public Health Genomics puts it, the basic building blocks of future medicine will be:

Predictive = predicting disease

Pre-emptive = preventing diseases

Personalised = highly precise personalised diagnosis and treatment

Participatory = patients play an active decision-making role in their health care.

I will reciprocate President, Xi Jinping quoting Shakespeare by quoting a Chinese proverb:
前人栽树,后人乘凉 “One generation plants the trees, another enjoys the shade”

Well, where healthcare delivery and healthcare quality and safety is concerned we had better start planting some forests because time is running out.

There are a number of reasons for us reaching this current position, where we are clearly heading for a fall, and soon.

One is the tyranny of the political cycle.

When did you last see a politician make a decision about anything that did not have a direct bearing on returning her/him to office in an election just months away? So it is not surprising that in the lead up to an election politicians focus on visible and popular themes like reducing waiting lists. Noble enough a quest, but the way they do this is by throwing money at half-baked schemes that might impact until after the next election then everything falls back in a heap. How do you really reduce waiting lists?………preventative medicine, stop people getting sick in the first place. BUT, that is not what the public, aka voters, want to hear because it will not impact for maybe two decades. BUT WHEN IT DOES IT WILL BE A CURE, PERMANENT, NOT A QUICK FIX OR BANDAID.

So how do we break this insidious cycle?

Is it possible to contemplate healthcare policy being formulated independently of politics? By a statutory body perhaps? But this usurps the proper political process, doesn’t it? Desperate times call for desperate measures and I am not overstating how desperate the future of healthcare delivery is if we do not take bold steps. If we do not remove healthcare policy from politicians we will need bipartisanship to achieve any serious long-term future planning and given the, by and large, schoolyard approach of politicians to any sense of bipartisanship, I wouldn’t be holding my breath on this one. The problem is, removing any major program from the political arena and placing it in the hands of an appointed rather than elected forum starts to erode the very tenets of democracy.

So, if the partisan politicians are incapable of taking a longer term approach to remodelling healthcare, if bipartisanship is highly unlikely, and if a statutory approach starts to look like dictatorial control, where does that leave us? Perhaps it is up to bodies like ISQua and the organisations to which you belong and to you and me to continue to fight the good fight and hope for a miracle.

Peter Carter
Chief Executive Officer
November 2015

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