Delivering worse health services?

Earlier this month was Delivering Better Health Services, the 2009 joint annual conference by the Health Services Research Network and the National Institute for Health Research’s Service Delivery and Organisation Programme. As an SDO-funded researcher, I was asked to present and my talk is now available here. I discussed our meta-narrative review of electronic patient records and work on the anti-coagulant service based at the Whittington Hospital. This work suggests that we need a greater focus on communication across boundaries, and an ongoing praxis involving clinicians, informaticians and researchers.

For a conference on delivering better health services, it was remarkable how several talks described the delivery of worse health services, a result of the distorting effect of targets on clinical care or problems with financial conflicts. Prof. Steve Shortell, from Berkeley’s School of Public Health, opened the first day with a focus on integrated care, how it demonstrably improves health outcomes and the importance of appropriate funding models. Much that followed that day considered how the NHS’s recent focus on the choice agenda and an internal market directly works against achieving integrated care. Notable here was Matthias Beck’s analysis of the Local Improvement Finance Trust scheme, a miniature public-private partnership scheme for the NHS, which delivered their immediate goal of procuring modern buildings, but at much greater cost than expected.

Dr Henry Potts