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The 2020 Public Services Trust Blog

Thursday, January 21, 2010

Prevention is better than cure: its official?

By Henry Kippin

“Finally we have it: pilot-tested, fully costed, independently evaluated, cast iron evidence that investment in preventative social care services more than pays for itself in savings to the NHS.”

This is David Brindle in yesterday’s Guardian, citing newly published research on the Partnerships for Older People Projects (POPPS), which were set up in 2005 to explore preventative approaches to care through focusing on human needs – loneliness through isolation, poor general health and social disconnection.  The project explicitly aimed to reduce ‘hospital based crisis care’ for older people. 

Policy advocates for preventative approaches should be pleased at these results – overnight hospital stays reduced by as much as 47%, for example.  Jamie Bartlett wrote a good report at Demos about the value of thinking preventatively, and this is more evidence to support a pragmatic, sensible and long-term way of thinking about health and social care. 

As David Brindle points out, the real value of this approach will be found if we start to think about preventative spending across current departmental lines.  He also makes a good point about the potential tension between policies that would promote cooperation and resource pooling in this way, and those that encourage competition.  To get round some of these issues, we need to think more about need, place and scale; and less about institutions and service categories.  This is obviously difficult. 

What also made me chuckle is how difficult it is to turn something that sounds like common sense into a policy idea that could feasibly be rolled out.  “Pilot-tested, fully costed, independently evaluated, cast iron evidence”.  If only Newcastle United’s transfer policy had been so rigorous.

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Posted by Henry Kippin at 12:07 pm
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Wednesday, June 24, 2009

Obama, Healthcare & the Hard Choices facing Progressives

By Henry Kippin

Today’s Wall Street Journal carries an opinion piece by Robert Reich on the progress (or otherwise) of Obama’s health care reform plan through Congress.   Ive been meaning to write about this for a while, and this mornings article prompted me into action…. 

 

Obama is effectively trying to re-model a system by inserting a public player into an already (mis)functioning market.  The problem is essentially two-pronged: first, lots of Americans (Reuters estimates 47 million) do not have access to health insurance; and second, the cost of the existing private insurance system is both expensive and variable.  A lengthy article in the New Yorker recently set out the issues at stake here. 

 

So Obama’s intention is to establish a public insurance plan.  This would compete with private providers, providing a new cost and quality bar for private competitors.  The American public would theoretically then be able to purchase their medical insurance from a truly competitive (and thus better value-for-money) marketplace. 

 

This sounds like a good plan.  As Reich suggests, it is driven by tinkering with the incentives that underpin the private insurance market.  Currently, these are quite self-serving, resulting in a steady increase in costs for the consumer.  Reich contests that “those opposed to public opinion should ask how private plans can ever compete (with the public option).  The answer is they can and they should.  It’s the only way we have a prayer of taming health-care costs.” 

 

There are other benefits to establishing a public player within a mixed market like this (as I argued in a New Statesman piece a couple of months back).  As well as potentially reducing entry costs to health insurance, access to the information that a public provider will generate can help re-configure a market around new measures of quality and outcomes. 

 

The obvious question hanging over all of this is cost.  How will a public plan be paid for?  And where will the burden fall in terms of potential tax rises?

 

According to Reich, “no one wants to raise taxes or even be accused of thinking about the subject. But honest politicians have to admit that universal health care will require additional revenues. The likeliest sources are limits on certain tax deductions and a cap on tax-free employer-provided health care.”  So for the plan to be realized, the Obama administration will have to annoy the pharmaceutical giants, US employers and the middle classes.  Good luck. 

 

Whilst we observe this debate from afar, we should recognize that this is a living, breathing example of the ‘hard choices’ spoken about so often – by politicians, and by thinktanks like ourselves.  We should all watch with interest, and hope that a progressive approach in this case can set the benchmark for creative reform in other areas. 

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Posted by Henry Kippin at 8:18 am
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Friday, May 29, 2009

Health-Check for a Responsible Britain

By Henry Kippin

The RSA hosted a packed lecture yesterday from Andrew Lansley, Shadow Secretary of State for Health.  He talked on the subject of ‘Improving Health Outcomes for All’, sketching out a blueprint for a future Conservative Party policy agenda. 

 

Overarching themes were ‘responsiblity’, ‘reform not reorganisation’, ‘choice and empowerment’ and ‘efficiency’.  Some were better explained than others.  Anyway, here are my quick reflections on the main points:   

 

Empowering Frontline Professionals

The Shadow Secretary placed considerable emphasis on the need to empower frontline professionals – the most obvious example being GPs who, under Conservative plans, would be far stronger guardians of quality control, holding hospitals (for example) to account.  Questions here concern potential variation in service levels, and the potential capacity of GPs.      

 

From Targets to Outcomes

This shift of responsibility downwards would be representative of a broader move towards an outcomes-driven approach to public services.  Mr Lansley was unequivocal about the need to do away with top-down ‘tick box’ targets, and towards broad public health outcomes.  But as Matthew Taylor notes, one danger is that broad outcomes can simply become umbrellas for ‘proxy targets’.  And some targets may be necessary - does the Shadow Secretary’s position risk throwing the baby out with the bathwater?

 

Choice & Competition

The Shadow Secretary talked about the need for more and better in this area, as a means to make essential efficiency savings, and to drive up quality. There is broadly consensus across parties on this.  But this will be contingent upon…

 

Access to Information

The lecture set out access to good quality, comprehensive information as key to making a choice agenda work.  But as my colleague Matt Grist pointed out, Robert Shiller and even George Osborne have recently spoken on the need to get past the assumption of rational, economic decision-makers.  I can’t help feeling that more thought needs to be given to appropriate choice architecture in this area. 

 

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Posted by Henry Kippin at 2:41 pm
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