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