My studies show that the problems we think we have are not the problems we actually have. People are getting old we are told. People have deficiencies therefore we need more efficiencies because in this logic age = cost. The NHS will be unable to cope with the increasing demands that an older and ever more demanding public are making. The NHS is unsustainable is the logic.
Yet getting old in itself does not seem to be a problem for healthcare expenditure. It seems that a better predictor of healthcare expenditures is proximity to death. So much so that Wong et al say that not only is age a red herring but a "carpaccio of red herrings".
Why does dying cost so much? The work of Wennberg, Gawande, Marmot and Hadler gives some clues. For the sake of brevity, their arguments can be summed up, as Prof Mulley argues, as the medicalisation of old age. We offer too much to little effect when what really makes a difference to how long and how well we live are socio-economic factors and understanding the strengths people bring to a situation rather than their deficits. This is particularly true when people are dying, but it's a problem that runs through every element of how health and care services are currently provided.
I have found that 1.5% of the population served by a regular DGH consumes 50% of the resources. That is about 4,500 people. It is a tiny number of people that it is well within our gift to design more effective responses for. At the moment the system is currently blind to these people and the impact the system design has on them, staff and cost. The system takes the value demands they make and multiplies this by a factor of literally hundreds. We call these demands failure demands. The failure to do something or do something right for someone. Failure demand is rising, but the value demands people place on the system are more stable. And the failure starts with the way the system is designed - transactional and episodic because we think that is efficient and effective. It is not.
Rising to the Nicholson Challenge with more of the same functionalised approaches to generate efficiencies actually presents more of a risk. It is this approach that has got us here. Ironically it is the commercialisation of health and care and the commoditisation of people that is causing the very problems that the Coalition Government is turning to the private sector to solve. It won't work.
What leaders have seen in applying the Vanguard Method is that developing and tending to relationships over time has a dramatic effect on the demands that people actually make on the system. These leaders are realising that conventional management thinking is the problem, not the solution. They don't concern themselves with structural changes or payment mechanisms first. That can follow once they have knowledge. They let the person set the boundary of the system and pull on expertise as and when required. They focus on what it takes to live a good life or die a good death. The results are extraordinary.
We do not have the problems we think we have. Even if we did, we can't solve these problems with the conventional approaches we have anyway. Our system is designed to over treat and over supply wherever you are on the continuum. We can change this if we pay more attention to understanding and solving peoples problems by building better relationships.
Value demand is stable, not rising and the NHS is not dying of old age; it is dying of system generated consumption, confusing failure demand for "true" demand. More efficiencies from a conventional perspective is the wrong prescription. There is a better way.