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Want and need

28 October 2016 It’s half-term, in case you hadn’t noticed. Roads quieter and traffic lighter, with many staff taking a break with their families. However, the world of the NHS stops for no man or woman – people still need treating and not surprisingly we see a significant spike in Accident and Emergency attendances. The question many ask is why? The weather’s mild (more later), there is no evidence of a flu epidemic yet and there is no reason apart from the children are off school. Could it be that it’s too easy and we offer too much access? Many would argue that access is a key factor and that people are entitled to a quick, high quality offering. I don’t disagree if you have a potentially life threatening condition. However, there are many health problems which are an inconvenience and do at some point need dealing with but do we need to offer lightning speed treatment for everything that’s on offer? The danger is we promise more, quicker and higher quality for everything and we end up disappointing. We need to have a debate about what is important and how we can ensure access to services is focused on the people who need those services rather than those who want it whether they need a service or not. ‘Want’ and ‘need’ is a very interesting concept. We may have created in the NHS a want culture based around the view we are entitled to anything we want to support our health. This isn’t always true, we don’t need everything we think we want. The health service has to have the courage to say “you may want this intervention but you don’t clinically need it”. This week the Academy of Royal Colleges produced a list of 40 or so interventions that it believed didn’t add value when applied across the population. In some quarters there was outrage and annoyance that they had produced this list. But actually they are right. The health service has made major advances in the past few years and therefore we need to continually review the value of current interventions and in some cases stop doing things that allows the service to provide more new interventions with better outcomes. We have to get a message across to the populations we serve that need is more important than want. Monday started the week preparing for the CCG quarterly assurance meeting. This is the meeting where we have to present to NHS England how we have done over the last three months. We are measured on a raft of indicators – some of which only provide the latest dataset in 2013! You may ask how do regulators measure performance based on data that is three years old? Me too! There is other data which is current and we are still a significant outlier on dementia diagnosis rates across two of three CCGs, A&E 4 hour standard is a challenge and 18 weeks is starting to becoming a problem. All these standards indicate is that we continue to have lots to do to convince the regulators that we are on top of our brief.

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