In a now very famous article, “The genius of a tinkerer: the secret of innovation is combining odds and ends”, Steve Johnson describes how innovation must be allowed to succeed in face of regulatory barriers.
“The premise that innovation prospers when ideas can serendipitously connect and recombine with other ideas may seem logical enough, but the strange fact is that a great deal of the past two centuries of legal and folk wisdom about innovation has pursued the exact opposite argument, building walls between ideas”
“Ironically, those walls have been erected with the explicit aim of encouraging innovation. They go by many names: intellectual property, trade secrets, proprietary technology, top-secret R&D labs. But they share a founding assumption: that in the long run, innovation will increase if you put restrictions on the spread of new ideas, because those restrictions will allow the creators to collect large financial rewards from their inventions. And those rewards will then attract other innovators to follow in their path.”
Bundling of goods can offend competition law, so that’s why legislators in a number of jurisdictions are nervous about ‘integrated care’.
In the past, Microsoft has accused of abusing Windows’ dominant status in the desktop operating system market to give Internet Explorer a major advantage in the browser wars.
Microsoft argued bundling Internet Explorer with Windows was just innovation, and it was no longer meaningful to think of Internet Explorer and Windows as separate things, but European authorities disagreed.
There’s no doubt that ultimately ‘whole person care’ will be some form of “person centred care”, where the healthcare needs (as per medical and psychiatric domains currently) are met.
But it is this idea of treating every person as an individual, with a focus on his or her needs in relation to the rest of the community which is the most challenging aspect of whole person care.
Joining up medical and social care with an ‘unified care record’ has never been attempted nationally, but it makes intuitive sense that care information from one institution should be made available to another.
Far too many investigations are needlessly repeated on successive admissions of the same patient, which is exhausting for the person involved. It would make far more sense to have a bank of results of investigations for persons, say who are frail, who are at risk of repeated admissions to acute hospitals in this country.
And this can’t be brought in with the usual haphazard ‘there is no alternative’ and ‘a pause for consultation’ if things go wrong. The introduction of the Health and Social Care Act (2012) and the CareData makes one nervous that lightning will strike a third time.
Labour has had long enough to think about what could go wrong.
Care professions might feel themselves ill-prepared in person-centred care. A range of training needs, from seasoned physicians to seasoned occupational therapists, will have to get themselves oriented towards the notion of a ‘whole person’. This might involve getting to grips with what a person can do as well as what they can’t do.
The BMA will need to be on board, as well as the Royal Colleges. Doctors, nurses, and all allied health professionals will have to double declutch from the view of people as problem lists, and get themselves into a gear about their patients as individuals who happen to be well or ill at the time.
This needs strong leadership, not people proficient at counting beans such that the combined sum total of a PFI loan interest payments and budget for staff doesn’t send a Trust into deficit.
Nor does it mean hitting a 4 hour target, but missing the point as a Trust does many needless admissions as they haven’t in reality fulfilled their basic admissions assessment fully.
For too long, politicians have been stuck in the groove of ‘efficiency savings’, ‘PFI’, ‘four hour waits’, and become totally disinterested in presenting a person-oriented service which looks after people when they are well as well as when they’re ill.
Once ‘whole person care’ finds its feet, with strong leadership and evident peer-support, we can think about how health is dependent on other parts of society working properly, such as housing and transport.
Technology, if this means that a GP could immediately know what a hospital physician has prescribed in real time in an acute admission, could then be worth every penny.
For the last few years, the discussion has centred around alternative ways of paying for healthcare instead of thinking how best to offer professional care to patients and persons.
The fact that this discussion has been led by non-clinicians is patently obvious to any clinician.
Technology also has the ability to predict, say in thirty years, which of the population is most likely to develop Alzheimer’s disease. Do you really want one of your fellow countrymen to have health insurance premiums at sky high because of having been born with this genetic make-up?
A lot of our problems, like the need for compassion, have been as a result of the 6Cs battling head-on with a 7th C – “cuts”. It’s impossible for our workforce to perform well if they haven’t got the correct tools for the job.
Above all, whole person care needs strong leadership, not just management. And if we get it right the NHS will be less focused on what it’s exporting, but more focused on stuff of real importance.
