Coproduction: A new healthcare model for the 21st century
Tuesday 16 April 2013By:
- Clive Miller
Our current model of health care is based on clinicians deciding what treatment will work best for patients and requiring, (sometimes supporting), their compliance with the treatment programme. Whilst this approach has served us well in the past, in the face of the rising tide of long term conditions, it has faltered and stalled. Something else is required to complement clinical expertise and health services. The answer lies in recognising what people and communities want and could do for themselves and reorienting and reshaping health and other services to support them. This shift from a clinician to a coproduced approach to health is at the heart of both OPM’s round table paper and the series of reports now being issued by the Innovation Unit’s, NESTA funded, People Powered Health project.
Both the People Powered Health project and OPM’s paper provide the evidence that coproduction improves health and produces consequent savings through reduced use of A and E, GP consultations and hospital admissions. The People Powered Health project’s Business Case for coproduction shows savings of between 7 and 20 percent, taking into account an investment of between £100 and £400 per patient. However targeted approaches and a wider view of the range of coproduction approaches that could be used, may produce even better yields.
The new coproductive approach goes against the grain of the current clinician-led NHS. It requires major culture change with patient’s ‘lived experience’ being given equal weight alongside the expertise of clinicians. The new approaches will also require a redesign of pathways around people, rather than diseases, and a reshaping of budgets and incentives. The potential benefits include: people gaining control over and improving their own health; clinicians increasing their job satisfaction as they visibly make a difference; and commissioners realising cost savings that help secure the long term future of the NHS.
NESTA and the Innovation Unit are now looking for partners to implement the coproductive approach across whole health economies. As we envisaged in our recent paper, OPM believes this will involve the implementation of a portfolio of coproductive approaches such as shared decision making, Expert Patients and Year of Care programmes, along with community based approaches such as that of the Heath Empowerment Leverage Projects and the use of self-directed support underpinned by personal health budgets.
The shifts required to enable effective coproduction in health are mirrored in social care. Refocusing on the assets of people and communities, what In Control refers to as ‘real wealth’, and redesigning social care to support people’s own efforts provides the way forward. Health and Well Being Boards spanning health, social care and other partner sectors are strategically well placed to drive forward an integrated, coproductive approach to improving health and well being. The extent of reductions in the adult social care budget means that squeezing further efficiencies out of the current model of care is unsustainable; given this, coproduction must be at the core of the new health and social care integration agenda.
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