Solving the NHS Care and Cash Crisis:

‘Solving the NHS Care and Cash crisis: Routes to health and care renewal', is co-authored by Lord Norman Warner, Health Minister for NHS reform in the Blair Government, and Jack O’Sullivan.

Published in April 2014 by Reform, the independent think-tank, the 128-page report sets out a bold, but minimally disruptive, programme to improve health while increasing affordability and reducing pressure on other public services during the coming five years of planned austerity. It proposes the biggest change in the relationship between individuals and the State in healthcare - around co-produced health -since the foundation of the NHS.

The report is the most discussed publication by a think-tank so far this year. Every London-based national broadsheet and tabloid reported it and the authors took part in more than 25 radio and television interviews, including Sky News and BBC Radio Four’s ‘Today’ programme.

The Guardian published a Comment Page article, by the authors, entitled ‘£10 each can save the NHS’ . The BBC published our blog, entitled: ‘Should we pay a monthly membership fee to the NHS?'. Together, these pieces, alone, produced more than 2,000 on-line comments on the day.

The report recommends shifting investment into much improved community-based health; creating a new partnership between the NHS and citizens; concentrating specialist services on fewer sites; hypothecating extra tax funding; merging health and social care budgets and service delivery.

Jack O’Sullivan said: ‘Our proposals would prevent NHS from starving the rest of the public sector of resources, would bring health and care models up to date and ensure long-term financial sustainability for the NHS. Our plans don’t require another big reorganisation or lots of hospital closures. They focus the NHS on what it can do with you rather than on what it can do to you.’

Key recommendations include:

Radical partnership between State and citizen

• Everyone to gain NHS Membership entitling people of working age to an annual Health MOT, planning ‘co-produced’ health over the year. £10 per month membership fee collected with Council Tax to fund local preventative health care.

New National Health and Care Service (NHCS)

• Services refocused on early intervention in community for both managing chronic and mental health conditions and preventing illness. Many existing hospitals become hubs for integrated services closer to home. GP practices consolidated or federated.
• Integration of health and social care budgets and services, under Health and Wellbeing Boards.
• Specialist services concentrated in fewer, safer, more expert 24/7 centres plus improved transport links with community-based services.
• On 5 July, 'Health and Wellbeing Day', the new NHCS would provide a Citizens’ Audit, reporting on performance and costs plus a detailed local report on community, primary and social care services, and specialist hospital services.

Stricter financial discipline

• Tougher efficiency programme raising £15-20 billion to fund new Service Transition Fund (STF), allowing investment in new community health and care services. Efficiencies include converting under-used NHS estate to raise cash for STF.
• Attendance Allowance integrated into the health and care budget, saving £6 billion a year.
• NHS ‘Continuing Care’ becomes part of means-tested social care, saving up to £4 billion a year.

New funding methods

• NHCS funding from general taxation to be frozen in real terms.
• NHCS to receive 1 per cent increase per year above inflation, funded not from income tax but from:
  • Tougher, hypothecated, inflation-proofed “sin” taxes on alcohol, tobacco and gambling and new taxes on health-damaging, sugary foods.
  • Wider payment of inheritance tax.
  • Inflation-proofing prescription and dental charges.
  • 'Hotel charges' for overnight stays in hospital.
  • Full cost holiday vaccination charges.

NHS should use modelling approach to resolve A & E Crisis:

‘Emergency Simulation’ is a new study, developed by the consultancy for The Cumberland Initiative, a unique partnership of academics, industry and clinicians for test-driving change in the NHS.

Computer modelling and simulation of solutions to the NHS winter A&E crisis, currently being pioneered in a number of NHS Trusts, should be adopted across the health service, argues the report, published in January 2014. Computer modelling provides a safe, inexpensive way to try new methods and avoids the unintended consequences of bed closures and changes in primary and social care that can lead to A & E crises, says the report, launched by Mike Farrar, former Chief Executive of the NHS Confederation and Lord Norman Warner, former Health Minister for NHS reform, at an event in Westminster, which is organised by the consultancy.

Examples of using computer modelling of changes highlighted in the report include:

Cardiff: Modelling has shown that A + E demand is actually generally stable and crises are largely due to increases in attendance by people aged over 75.

South Wales: Mathematical modelling convinced managers that some of the UK’s poorest ambulance response times could be tackled effectively by speeding up hospital turnaround rather than increasing numbers of ambulances.

Torbay Hospital, Devon: Modelling has convinced managers and clinicians to rethink a bed closure plan.

Nottingham: Modelling has shown that the best way to reduce bed occupancy and improve emergency and unscheduled care was neither early discharge nor separating majors from minors in the Emergency Department, but via measures to keep elderly patients out of hospital.

Lincolnshire: Modelling has recently given managers in Lincolnshire the confidence to invest in a GP presence in A + E, to create intermediate care and to close acute beds. And simulation is being used to develop innovative funding mechanisms supporting integrated health and social care for people with long-term conditions.

Think O’Sullivan has also developed Cumberland Initiative’s website.

We have been working with two key organisations instrumental in developing Muslim identity in Britain and the contribution of Islam to civic society.

The Radical Middle Way, led by Fuad Nahdi, has built an important dialogue with Muslim youth all over the world by bringing international Islamic scholars to major events, recording and disseminating their views on key issues.

The An-Nisa Society, led by Humera Khan and Khalida Khan, is a Muslim women’s organisation that has done vital community development work in Britain. ‘Happy Muslims’ – RMW and An-Nisa recently produced a brilliant video that has gone viral, based on Muslims singing and dancing to Pharrell’s song, ‘Happy’. To view it: http://www.independent.co.uk/news/uk/this-britain/pharrell-williams-happy-british-muslims-dance-to-song-in-video-9265188.html

The consultancy worked on a joint project with the Radical Middle Way and An-Nisa on a symposium about Islam and the voluntary sector, entitled ‘Faith, Khidmah and Citizenship: Connecting Spirituality, Social Action and the Big Society’. We produced a report on the event that went to the Communities Secretary, Eric Pickles MP.
Read more: http://www.radicalmiddleway.org/article/download-the-report

Working with the Fatherhood Institute , and An-Nisa, we also produced a unique ‘Prayer and Praise’ guide for Muslim Fathers. The tiny booklet, which is now in the wallets of many Muslim dads, includes a daily prayer timetable with thoughts and advice on fatherhood.

Jack O’Sullivan writes occasionally in the mainstream press about Islam. His articles include:

'British Muslims are the New Irish: A piece in the New Statesman suggesting how the history of 19th century policies towards Irish immigrants might inform 21st century public policy supporting British Muslims.' Read more: http://www.newstatesman.com/node/146622

'If you hate the west, emigrate to a Muslim country': An interview published in the Guardian with Hamza Yusuf, arguably the West's most influential Islamic scholar, in the aftermath of the September 11 bombing of the World Trade Center.
Read more: http://www.theguardian.com/world/2001/oct/08/religion.uk

'Defender of his faith’: An obituary in the Guardian for Zaki Badawi, one of British Islam’s first leaders and founder of many Islamic institutions in Britain. Dr Badawi first used the term ‘British Islam’. Read more: http://www.theguardian.com/world/2003/jan/15/terrorism.religion

The bridge to 21st century infrastructure for healthcare

We’re helping with strategic and communications support to build the new Healthcare Infrastructure Forum (HIF).

HIF is unique – the only international centre dedicated to improving healthcare delivery that is focussed on infrastructure. HIF will be vital to the NHS as it begins to overhaul community, primary health and social care services, which the main political parties now see as vital to diverting activity away from the more expensive acute hospital sector.

HIF creates independent and informed debate and helps to implement healthcare policy for governments and for healthcare organisations through forum discussion, consultancy and research. It involves collaboration between UK universities, partnered with the European Centre for Healthcare Assets and Architecture.

HIF springs out from the Health and Care Infrastructure Research and Innovation Centre, an £11m EPSRC-funded programme for which Jack O’Sullivan is Communications Director, HaCIRIC.

Evidence for Developing Social Care Policy and Practice

We are supporting more than 50 projects, particularly around communications, in the NIHR School of Social Care Research at the LSE. The school is at the cutting edge of research, developing particularly economic evidence for interventions that help people with disabilities, elderly people and adults living with mental illness.

To read some of the case studies that we have developed for the School, click the following link: http://www.sscr.nihr.ac.uk/projectinsights.php

The research is especially important as social and health care compete for funding and social care risks missing out because of the higher levels of investment in healthcare research, particularly around return on investment. This programme is beginning to level the playing field because, with the leadership of Martin Knapp, Professor of Social Policy at the LSE, there is, at the SSCR, a strong focus on economic evidence and cost benefit analysis. As policy makers plan more to divert spending into social care, in order to secure long-term savings and better outcomes, this evidence will be vital to spot the best areas for extra investment.

As public health policy returns to a more Victorian agenda based in the environment, we’re supporting communications around new research at the NIHR School for Public Health Research at the London School of Hygiene and Tropical Medicine.

We’re helping researchers to bring their work and thinking to wider audiences and, in particular, to policy makers. sphr.lshtm.ac.uk/2014/02/03/blog/

Some of the interesting subjects that we have explored lately include debates about: whether use evidence in policy health policy-making is subject to systematic bias; how engagement with minorities improves health outcomes; the role that evidence has played in introducing minimum pricing per unit of alcohol in Scotland; the public health outcomes of urban regeneration.

Jack O’Sullivan launch-edited the first edition of Editorial Intelligence, the house magazine for Julia Hobsbawm’s EI consultancy on the comment media.

We have a particular expertise in working with the Comment media because Jack was Comment Editor at The Independent newspaper and wrote regular columns on social policy for the paper. We continue to support clients who wish to write for the comment media, helping to draft articles for them and to advise on how to look at subjects in ways that will interest policy makers and the general public.

Jack also writes for newspapers in a personal capacity on different aspects of health and social policy, gender and Islam.

Articles include:

‘£10 each can save the NHS’:’ This piece sets out the key recommendations of ‘Solving the NHS Care and Cash Crisis’, by Norman Warner and Jack O’Sullivan, published by Reform in April 2014, including a radical shift towards co-production of health via a new partnership between individuals and the state.
Read more: http://www.theguardian.com/commentisfree/2014/mar/31/10-pounds-eachsave-nhs

‘The masculinity debate: no wonder men stay out of it.’ This piece explores the reasons why men tend not to participate in discussions about masculinity, despite the assumption that they are powerful and have access to the media. It suggests that the often hidden power dynamics of the home help to explain the paradox.
Read more: www.theguardian.com/commentisfree/2013/may/21/masculinity-debate-men-fear-ridicule-matriarchy

‘Tradition is the enemy of happy families’. This article explores research by two remarkable US academics, Philip and Carolyn Cowan, who have been studying what makes modern couples tick. It argues: ‘Something tragic happens to apparently modern British couples at the patter of little feet. We all see it, if we are honest. Two people, in love, raised in and committed to values of equal partnership just seem to lose it. Amid all the joy and ambition, many of them are quietly, inadvertently and perhaps irrevocably pressing the couple-destruct button. Dad gets "provider fever", works harder, and gains economic power over his partner – and enhanced relative power in the public realm. It's a disheartening reversal: a "patriarchal moment". Meanwhile, mum has her "matriarchal moment", winning domestic control, largely taking over the private and social realms. Ancient norms reassert themselves despite the couple's vows to do things a different way. After that, fathers and mothers rarely relinquish their respective powers. Yet there is a bitter twist: this power is claimed at a cruel price.'
Read more: www.theguardian.com/commentisfree/2013/mar/07/tradition-enemy-happy-families

‘Breon O’Casey, artist’ An appreciation of the artist Breon O’Casey, whose biography was written by Jack O’Sullivan. Breon was a versatile artist and craftsman and a prominent member of the St Ives school. Read more: www.theguardian.com/artanddesign/2011/may/31/breon-ocasey-obituary

‘Defender of his faith’ An appreciation of Zaki Badawi, one of British Islam’s first leaders and founder of many Islamic institutions in Britain. He coined the term ‘British Islam’.
Read more www.theguardian.com/world/2003/jan/15/terrorism.religion

We’ve been at the forefront of new thinking about how to encourage maximum involvement of fathers for the benefit of their children’s development.

Jack O’Sullivan launch-edited the first men’s consumer magazine for fathers, entitled ‘Dad’.

The design was novel, the first such magazine that took its lead not from parenting magazines, but men’s consumer magazines'. So there was no baby on the cover and no pink imagery! The launch edition included an interview with Pierce Brosnan, a man who has combined many different roles of fathering, including being a step father and a lone father. The launch of the magazine was held at 10 Downing St, where Tony Blair picked up a copy to read on the plane en route to a summit with President George Bush.

Jack is also author of ‘He’s Having A Baby’, the BBC Guide to Fatherhood, which takes dads through from conception to teenage years. Read more: www.amazon.co.uk/Hes-Having-Baby-Jack-OSullivan/dp/1405312610

Jack is a co-founder of the The Fatherhood Institute, Britain’s leading think tank on fatherhood, which has played an important role in changing perceptions, public policy, practice and work place entitlements related to fatherhood.

Tackling healthcare inequalities related to race

We developed the first web-site for the NHS focussing specifically race and health www.raceforhealth.org

Inequalities in health outcomes are most pronounced around race and ethnicity, having a huge impact on conditions such as diabetes, heart disease, certain cancers and mental health.

Race for Health was a highly innovative DH programme that tried to improve practice across the country. On the Race for Health website, we have tried to save a lot of the learning so, when the will is there, real action can be taken to pursue this agenda more vigorously.

New blogs translating vital academic research into public discussion

We’re developing new ways for policy makers and opinion formers to access the latest thinking on child and family welfare. In Summer 2014, we will be supporting launch of the new, web-based Child and Family Blog, an initiative developed by the world’s leading researchers into family and child welfare, in a transatlantic collaboration between the universities of Princeton and Cambridge.

We are working with bloggers to make sure that their contributions really sum up research well and bring to the attention of non-academics and policy makers in an accessible way.

Understanding why gender is important in improving health

Jack O’Sullivan put together ‘Improving the Health of Women and Men’, a guide to the evidence and policy options for focussing on gender in improving health care. It has been very important to look at the very many different ways that gender can impact on health.

This is vital because gender and health is often seen as a competition between men and women for healthcare resources. In fact, it is a struggle to convince people that, if we look at health through the lens of gender, we understand people and their needs much better. So, it is an area of great cooperation, not competition, between men and women.

‘End of the Sex War’: Following publication of ‘Improving the Health of Women and Men’, the New Statesman commissioned Jack O’Sullivan to write a cover story for the magazine entitled ‘End of the Sex War’, setting out how gender cooperation rather than competition was now emerging in a number of areas of social policy, notably health, parenting and education. Read more: http://www.newstatesman.com/node/147327

Getting the right infrastructure in the right place at the right price

We have supported communications at Community Health Partnerships, which has coordinated the Government’s programme to develop improved primary healthcare facilities over the last 15 years.

We worked on a number of aspects of communications, in particular putting together ‘Firm Foundations’, a guide to the best processes and approaches to commissioning and developing healthcare infrastructure that delivered the services and outcomes required in a cost effective manner.

Looking at how evidence and policy interact and the relationship can be improved.

How can links be improved between evidence and policy? We’ve been helping two Department of Health Policy Research Units, in particular the Policy Innovation Research Unit, developing its website and blogs.

It’s focussed on issues such as evaluation of the Responsibility Deal, a partnership between the Government and business to promote healthier lifestyles, eating and drinking. Read more: www.piru.ac.uk