Prof Paul Corrigan, a former advisor to Tony Blair has argued that, unless radical action is taken the NHS will need to find £5bn to bail out failing hospitals. Some hospitals will, therefore, need to close, but its OK because the model of care that replaces it will be better. It's not the first commentary on this topic, with Lord Crisp being the most recent high profile commentator to argue this.
It is hard to disagree with some of the conclusions, given what I have seen to date having applied the Vanguard Method in health. What concerns me though is that the logic that is driving these conclusions is one of managing cost and not managing value. Unfortunately, the reality is that if you manage costs, your costs go up. What leaders who apply the Vanguard Method understand is that cost is in flow - manage value, end-to-end, from a users perspective, and your costs will go down.
There is plenty of evidence to support this, perhaps the most obvious one being walk-in centres. Everyone had to have one of these, millions were pumped into building them on the basis that they would take care of the "ambulatory care sensitive" cases, A&E attendances/admissions would go down and everyone's a winner. Patients get care closer to home. Commissioners save money. Trusts create capacity. Only trouble is that they proved to be so popular they became unaffordable, particularly as there seemed to be little or no impact on what was coming through the front door of the hospital. Overall costs went up. Managing costs had the opposite effect to that intended.
Better would have been to design a system to respond to people in the right way when they put their hand up for help based on knowledge and understanding, not create another service solution based on instinct or convention. Fortunately, when PCTs started closing them, the managers in charge could at least pat themselves on the back for having made a significant contribution to their efficiency savings....
If it is true that hospitals will need to close, better to make decisions like that from a value, not cost point of view. By doing so we will be sure to be cutting that which ought to be, not that which can be. We are then in a position to build our business models based on knowledge not convention.
The concept of "solution factories" again sounds plausible, but right now, fills me with dread. If centres of excellence are not determined from a value point of view then this could be another example of blindly plumping for a model based on an assumed economy of scale.
I worry that decision makers will opt for approaches like this without first understanding what perfect looks like from a users perspective. The risk is they apply current convention and logics of cost and activity as the basis for change. If that happens then as plausible as Prof Corrigan's analysis might be, it is almost certain that the wrong decisions will be made, with the system ending up paying more, not less for the new model.