Chronic New Initiative Syndrome

It seems absurd that the same government that spouts so much guff about "joined up care", "integrated patient care pathways" and other equally noble sounding objectives, is the same lot that bombards from all points of the compass with new initiatives. One of this month's flavours tastes of "Long Term Conditions". Pareto still rules and the "80/20" rule is as valid for patients and costs as it is in commerce for customers and revenues.

Some patients have permanent health problems that will require medical support for the rest of their lives. They represent the largest single cost to the taxpayer so getting their care wrong will in turn be the largest single waste of NHS funds. "Long-term conditions" now attracts the attention of The Management. Reducing 5% of the biggest cost saves billions of pounds. So far so good. As always, it is in the execution that all hope of simplicity is abandoned.

Down in our neck of the woods, we have now had about four separate initiatives "addressing the issues" of patients with long-term conditions. Teams of well-meaning, kindly people come and tell us why things are going to be ... better .... connected ..... coordinated .... None of them talk each other. All of them are only funded for a couple of years (as a trial). All of them are designed to provide "navigators" or "modern matrons" or "enhanced nursing services" and each of them will provide a single?? point of contact for the patient. If only.

They are, in essence, additional and duplicate layers helping these patients to claim benefits, arranging care from social services and generally trying to be helpful. Patients (or as the new breed insist, "clients") get to know their new navigator/coordinator/matron/ whatever and start to build a relationship with them. The professional spends most of the first year learning how local services and local variations of national services are provided. They also raise the expectations of their "clients". Then the funding runs out, or there aren't enough staff because demand was underestimated, or the carer, navigator, advocate, matron, or whatever has left and "we're recruiting a replacement soon".

I like to think that sooner or later, Whitehall will realise that asking those responsible for the poor execution of health delivery (which means the poor management of health delivery) to deliver new and different services is as daft as asking the Child Support Agency to help single parents - and how daft is that?