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Seminars and Debates
Civitas holds a number of health seminars and debates, which aim to explore some of the most poignant issues in the NHS and look at whether we can learn from the heath care reform experience in other countries. A number of discussions with key figures have also taken place as part of Young Civitas for Medics, which you might be interested in listening to here. On this page: Seminars on NHS reform | Seminars on health systems
Seminars on NHS reform
'This house believes that a market will deliver quality and efficiency in healthcare better than central planning ever could' For:
Against:
Chaired by Martin Rathfelder, Director, Socialist Health Association The Labour government have recently shown signs of back-tracking on the use of markets in the NHS, but are they right to? Or should we, in fact, be pushing competition as the best means to escape the financial difficulties facing the NHS? View write-up in British Medical Journal. Homeless health: a blight on this house
With commentary by Hilary Armstrong, MP The average life expectancy of a homeless person is 40.2 years. In the average teaching trust in London, homeless people attend six times more than non-homeless; they are admitted four times as much; and stay twice as long, not because they are bed-blocking but because they are at least twice as sick. They also have twice the incidence of cancer. Projects are emerging - and in some cases have existed for some time - to take the lead in providing specialist services for the homeless. However, as they build momentum, they are surfacing an enormous number of issues that haven't been addressed and remain a miscarriage of health within a health system that prides itself on being universal. Can a coherent, holistic, strategy be developed to provide healthcare for the homeless? And what needs to change to enable this to happen? Academic Health Science Centres: world class ambitions
There is a long-standing quandary in UK healthcare: despite having world-class medical research institutions, even the best NHS hospitals do not compare favourably with the clinical outcomes achieved by the best hospitals in the world. Both speakers put a powerful case that AHSCs, in formally integrating healthcare services with teaching and research, and offering up the possibility of fast-tracking research from 'bench to bedside', could provide a solution. 'For 60 years', contended Professor Smith, 'isolated university departments and isolated NHS organisations have not delivered for patients. We need new ways of working.' A brief commentary can be viewed here. Presentations: Clinical leadership: lost, or at a new dawn?
With commentary by Eileen Sills, CBE, Director of Nursing, Guy's and St. Thomas's NHS Foundation Trust 'Quality', wrote Lord Darzi in his recent Next Stage Review of the NHS, 'is improved by empowered patients and empowered professionals. There must be a stronger role for clinical leadership and management throughout the NHS'. A raft of measures to encourage its development has been proposed, but will they be effective? Is this a new dawn, or merely a false beginning? Commission impossible? Is world class commissioning achievable in the NHS?
With commentary by Professor David Fish, Medical Director, UCLH NHS Foundation Trust. The vision for 'world class' commissioning is all-encompassing, nothing short of 'delivering better health and wellbeing for all, better care for all and better value for all'. But what does 'world class' commissioning really entail? Is it really possible? Or is it, given the sheer complexities of health care and apparently contradictory structures in the NHS, something of an elusive holy grail? Polyclinics: a force for integration or disintegration?
With commentary by Professor Sir Ian Kennedy, Chairman, Healthcare Commission. Lord Darzi's Healthcare for London report, published last July, outlined ambitious proposals to introduce a series of polyclinics in the capital. While the national Next Stage Review may not take the London report as a template, it is likely that polyclinics are to form a part of Lord Darzi's conclusions in his national paper. But what is there likely impact? Are polyclinics the emperor's clothes - it's certainly a new, untried, model - or could they serve as a means to the integrated care we all crave? The third sector and social enterprise in health: the way forward?
With commentary by Lord Mawson, Founder, Bromley-by-Bow Centre. With the focus of the Next Stage Review and the drive for world-class commissioning squarely on creating an NHS that is 'clinically-driven, patient-centred and responsive to local communities', social enterprise and the third sector more generally are once again being touted as a significant part of the solution. But what can it offer and is it the means to more patient-centred care? Competition: the solution to the NHS's problems?
Since the publication of the NHS Plan in 2000, health reform in England - at least for planned hospital care - has broadly focused on creating the conditions necessary for competition between providers: choice for patients, greater diversity in provision, payment-by-results and a proper regulatory framework. The NHS Operating Framework for 2008/09 confirms this is very much here to stay, but is it the best way forward? The Foundation Trust Experiment and UCLH: Has it worked, should we go further?
Sir Robert Naylor, recently described in the HSJ as one of the more 'vociferous' supporters of Foundation Trusts, argued persuasively that not only has Foundation Trust status with its associated financial and structural freedoms provided for both greater efficiency in use of resources, but also higher quality and more responsive care for patients. His presentation can be viewed here. Can the NHS become more innovative?
Having won a Medical Innovation Award in 2005 in recognition of his achievement in eliminating waiting lists through adopting a 'dual-surgery' technique, John Petri has now left the NHS to work in Switzerland, stating his 'disillusionment' with the incentives for surgeons to become more efficient. Drawing on his experience in the NHS, and previously in the French health system, John Petri provided an invaluable insight into why the NHS struggles to innovate. A report on his presentation can be viewed here. Can the NHS learn from American HMOs?
A comparative analysis in the British Medical Journal by Feacham et al. (2002) provoked much controversy by showing the American HMO, Kaiser Permanente, to be providing more efficient and high quality care than the NHS. Here Chris Ham draws on the implications of this. His presentation can be viewed here.
Seminars on health systems
Consumer choice and the regulation of medicines
Complaints are frequently made that regulatory agencies take too long to evaluate new medicines. Bart Madden has proposed a dual-track system under which all drugs that have passed Phase I safety tests would be subject to two regimes. Alongside the standard regime there would be a second track that would allow well-informed consumers to take the risk of suffering side-effects or adverse reactions if they think it is worthwhile. Should such a system be introduced? Are other changes in the regulation of medicines overdue? His presentation can be viewed here. Lessons for the NHS? Integrated delivery systems and patient-centred care
In numerous publications Professor Enthoven has advocated individual (cost conscious) choice of health care financing and delivery hinging on universal health insurance, akin to that recently introduced in the Netherlands, and integrated delivery systems such as Kaiser Permanente. In this seminar he reflects on his ideas and provides some pointers for the future development of patient-centred and integrated health care in the UK. His presentation can be viewed here. Listen again: integrated delivery systems (mp3); integrated delivery systems in the NHS (mp3); the importance of competition (mp3). Healthcare in the balance: Reassessing the roles of European governments and individuals in health care
Can we learn from other health systems? Civitas held a series of seminars from February to May 2005, aimed at seeking the best methods of combining economic viability and social solidarity in the provision of health care. The various presentations can be viewed here:
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