London Health 09 conference

On Monday and Tuesday this week I attended the London Health 09 conference. Day one was focused on local government and social care and day two on improving health outcomes for London.

All in all it was a very useful two days and it highlighted some really good things that are being done and also some fundamental problems.

It was attended by some very senior people including leaders of councils, advisers to the Mayor of London and senior executives in London NHS and local PCTs. They all had a very real need to do something good for the people in need in London and most of them felt a pull to do something different than had been done before. I was very encouraged by this, and if the rest of the health care staff in London are even half as committed then I am sure that some good things will happen.

I could write about many of the interesting talks but I will mention here a few that resonated or said something new.

The first was from Sir Michael Marmot from UCL. He presented research that showed that health inequalities were very strongly to do with social status. The bottom line is that if you are poor and uneducated then you will have a short life with multiple illnesses. His message was that even if social and health care were perfect they won’t lift people out of poverty and so you will still have people who need lots of care just because of the start they get in life. It is other policy areas that need to deal with the cause and cure of that societal malady.

The second session I would like to highlight was a breakout session on telehealth. This is simply when you give patients the means (equipment) to monitor things like blood pressure at home with a direct link that sends the data to a nurse or other professional. This demonstrated that you can give people independence, save staff time and reduce the incidences of hospital admissions. This seems very innovative and everyone was very impressed but I don’t think it is so clever. They said the units cost £2,000 to install, but you can get weighing scales that tweet your weight now. Having devices connected to the internet should not be so expensive. Or so surprising.

On the second day Dr Robert Chote from the Institute of Fiscal Studies showed us a lot of scary graphs that said that public finances are going down the toilet in the next few years. I think this is known in this community and a lot of the talk at the conference was about money and “doing more with less”. Interestingly, I had a conversation over coffee with one panellist who said that he thought that because NHS pay had increased over the past few years and at the same time the mortgage costs had fallen, that meant that a lot of NHS staff were feeling personally a lot better off than they ever had. He thought that this personal feeling of extra wealth was preventing people from digesting the coming budget crash and that their comfort was stopping them doing the things they needed to prepare. One of the speakers, Jim Easton, NHS National Director for Improvement and Efficiency, addressed the audience directly and said, “This [budget] problem is coming and if you are not doing something now, you are burning time.”

Lastly, there was a very interesting presentation from Conor Burke, Borough Managing Director, NHS Redbridge about an impressive scheme of polyclincs to join together social and health care services and run them together to remove duplication and budget wrangling between local authority and health services. I will comment further in another blog, but suffice to say there was a lot of talk about commissioning and joint working. Trying to make commissioning function better and putting together joint working between local authorities and PCTs is worthy, but it is really working around a big flaw in the system. The structure of the system shouldn’t make it difficult to work together but all the mentions of joint working were mentioned in ways that made it seem like it was an amazing job, how wonderful was it that we can get together and do this. Working together for the purpose of giving the best care to the residents of London should be the number one priority. It shouldn’t feel above and beyond to do that over simply delivering the services as mandated.

In the next few blogs I will talk more about commissioning, joint working, improvement methods (or lack thereof) and other topics.

Maybe I will see you at London Health 2010?

Best,

Rob