UK healthcare told – be the same but different

Integration and standardisation are the two watchwords for UK health policy at the moment. Integrated budgets working across health and social care should sit alongside standard approaches for workforce management and procurement. The former should improve health and user satisfaction but may not bring the desired cost efficiencies; the latter may save a few quid, but probably after some changes to the processes. Now we see that Monitor and the Trust Development Authority are to move to single leadership, no doubt to provide an integrated, standardised service.

Integration and standardisation are great, and just what I would expect from, say, a large US burger chain. Some things benefit from this approach; as the Department of Health statement said: “All hospitals need access to the same kinds of support.” It is a phrase that many healthcare suppliers will recognise. Processes are similar, and the healthcare technology required to deliver those processes can be similar. The people part can be a little more challenging, and sometimes this element can get left out of such plans. Change takes time, no matter how small the change.

Yet I am confused. Bringing everything together and making it the same seems at odds with a move to devolution. Locally-driven care makes sense, and can provide some great examples of innovation and common sense. But no amount of best practice sharing will remove the potential for multiple branches of Wheel Reinvention Ltd. More variation will emerge, which will no doubt lead to more reports that seek to minimise that variation.

Be the same but different; it is nothing new for the NHS, and those who seek to serve its capricious nature. We have to deliver to national targets whilst recognising that local needs still need to be met. Local services meeting national standards using the same brand of toilet roll may work on paper, but it’s no guarantee that the NHS can continue with its current funding plans. It has run out of money. We either stop living so long or start paying.