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CCG Series: ‘No more pilots’ for Liverpool CCG


28 May 2013

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The winter has been unseasonably long, and April has often felt like autumn. On 29th April there was spring snow across Spain, just one sign of this unseasonal weather. Working in the NHS has also been unpredictable of late with Accident and Emergency Departments across the country facing increasing pressure and under real strain. This is probably the greatest challenge facing the CCGs. We all have plans for ‘tomorrow’ but we have to face  up to the problems of ‘today’ as well.

The winter has been unseasonably long, and April has often felt like autumn. On 29th April there was spring snow across Spain, just one sign of this unseasonal weather. Working in the NHS has also been unpredictable of late with Accident and Emergency Departments across the country facing increasing pressure and under real strain. This is probably the greatest challenge facing the CCGs. We all have plans for ‘tomorrow’ but we have to face  up to the problems of ‘today’ as well.

Health Secretary Jeremy Hunt’s recent speech to Age UK picked this issue up and his speech highlighted some key challenges. Controversially, Hunt blamed the strain on A&E departments on the introduction of GP contractual changes in 2004. The British Medical Association (BMA) in its response expressed its concerns about the overly simplistic, inaccurate analysis of the huge pressures on accident and emergency departments.
Of course it is virtually impossible to compare attendance figures in accident and emergency departments from now to ones from 2004. They are calculated in a different manner and now include attendance at walk-in centres and minor injury units. But when we look at A&E attendances across the country they show slight increase in attendance but contract changes certainly don’t explain the pressures A&E departments are under.
Unfortunately the focus on A&E has the danger of missing the point as this is about unplanned care and the determinants of unplanned care. Dementia and increased frailty in a proportion of our elderly population are key challenges for CCGs. When talking to A&E consultants it seems that the departments and hospitals are under strain from these patients. Hospitals and A&E departments were not set up to deal with this complexity. For frail and elderly patients who often have undiagnosed dementia, hospitals are dangerous places. 
What we have to do conceptually is simple but the challenge is implementing it. Integration is the challenge for CCGs, just as waiting lists were the main challenge for PCTs. We have plethora of pilots which are held up as examples of good practice we should aspire to. But in Liverpool our slogan is ‘No more Pilots!’ because we don’t have the luxury of time. 
The role of the CCG is to have an oversight, scrutiny and challenge role, supported by a vision for the system. We need to understand the system as a whole and redesign it around needs of the patient. Primary and community services are a key part of the system. We all agree with the Health Secretary that we need to be proactive and have systems which are flexible and locally based. So let’s do this based on evidence and collaboration, not by blaming parts of the system. 
All opinions expressed in the blog are personal views from the perspective of the CCG chair, but they do not necessarily represent the views of Liverpool Clinical Commissioning Group. 
 
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If your CCG has something to share don't hesitate to contact Lalah-Simone Springer (lalahspringer@campden.com) to contribute to the CCG Series 
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