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Politics, Power & PersuasionPolitics, Power & Persuasion
Arun ChopraConsultant Psychiatrist, A42, QMCWPLC, RCPsych.
•Recent developments in healthcare Politics (lessons from Obamacare)
•Power & its structures
•Persuasion: Individual (health professional) & College
recent developments
contextual factors
health & social care act
clinical involvementcompetition (howe)‘no top down reorg’
urge to tinkerresponsibility
(bevan)extension of NL
policy?(warner)
its the economy, stupidsocial care
cutsperforman
ce
patient satisfaction fallen
Access: a&e waitsCVS gains
mental health accessinpatient survey
suicide ratesdetained patients
highest satisfaction ratinglowest waiting times
mh fundingtargets
mid-staffs-managers performance
and finance before patients
section 75
Labour- health policy review
H& SCact- primary legislation; delegated legislation: Statutory
Instrument
AMRoC
1000 doctors
Section 75: A week is a long time in politics...
The proposed regulations make fragmentation of care more likely.
Compulsory tendering could lead to deskilling within services and potentially reduce their quality and effectiveness.Compulsory tendering could lead to a deskilling in mental health, for example by other professionals being employed to lead services instead of consultant psychiatrists in order to reduce costs, despite evidence that consultant-led care justifies its extra cost in terms of benefit to patients.2
Briefing – The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 01.03.13
The Regulations contradict assurances given by the Government about competition during the passage of the Health and Social Care Act 2012.
Under the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years.
"If we look to the US the best providers are working on that highly integrated basis, co-ordinating physical, mental and social care from home tohospital. We need to take what's best and universalise it here." kings fund speech Jan 2013
ACO creates health planFinancial reward if ACO
keeps enrolled out of hospital
there would be a new role for
DGHs
care would move out of hospitals, but probably still led by hospitals
Fewer specialists; fewer specialist
centres
risks & challenges:social care- all the money goes
therenothing comes to mental health
structural reorganisation (not again)
general practice statustraining issues;- consultants
go?,pay??skill set of Local Authorities?
Local authority diversityNHS in its current format can’t continue
option 1-competition, more players
option 2-efficient, preventative (but)remaining responsive
Qn. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade? (lillian greenwood, Nottingham South (Lab), 27 Nov 2012)
Lobbying
attendance at the party political conferences
written evidence to select committees
briefing for individual MPslobbying on amendments eg, parity
of esteemprojecting ‘soft power’ e.g, Ed M’s
speechTory MPs essays on mental healthadjournment debates- ED, Scz.,
mental healthmental health discrimination act(by the way, we are recruiting ;))
And one last thought...
LHWBSLHWBS
pensions, CEA, pensions, CEA, paypay
NHANHA
CLAHRCs 2CLAHRCs 2
LETBsLETBs
PHBsPHBs
networksnetworks
AHSNsAHSNs