Doughnuts

A friend has just got a really swanky health economics job and we’ve just had a fun chat about doughnuts and donuts. In the end we both agreed donuts are great (in moderation though………. we believe in public health) but Kate Raworth’s book: Doughnut Economics- seven ways to think like a 21st century economist, is even better: http://bit.ly/2t2lfdd

I’ve had a stab at applying Kate’s ‘seven ways’ to health and care as I think they provide a framework to think differently about how we organise and deploy health and care resources…..what do you think?:

Change the goal: yes, lets focus on what matters to people not arbitrary 4hr/18 week targets in health and access thresholds in social care. There’s plenty of evidence to say people are a) willing to wait for the right service at the right time to get the best outcome:  and b) as taxpayers, pay more for health and social care as long any new tax is hypothecated https://www.health.org.uk/news-and-comment/newsletter-features/new-poll-shows-support-for-tax-increase-to-pay-for-health-an

See the big picture: This is about system thinking and many places have already embraced the integration of health and social care (although not many health bodies are willing to allow health budgets to merge with  adult social care budgets!) There maybe more scope to widen the current ‘closed’ system and spread the impact of social care budget pressures. Afterall the system should absolutely contain education, housing, employment, transport, criminal justice, regeneration etc etc etc. have a look at what Cheshire West Integrated Care partnership are up to in this area:  http://bit.ly/36qKDXv

Nurture human nature: wider system engagement would mean that the 80% of our lives, that we live outside of health and care services, can be brought to bear to keep us well; in safe places to live, in sustainable housing/communities with some friends and useful things to do which pay the bills. https://www.kingsfund.org.uk/publications/vision-population-health

Get savvy with systems: we hold masses of data on eachother and people expect us to use it to provide care (and plan services?) https://understandingpatientdata.org.uk/ but we are loath to do so because we misunderstand public concern (some of this is our fault http://bit.ly/2RsH1jz ). Risk stratification should be the starting point (see below)

Design to distribute; the outcome of savvy systems should be more appropriate resource allocation and who can argue with resources allocation based on need? Joint Strategic Needs assessments provide a good place to start this conversation. https://www.cheshireeast.gov.uk/council_and_democracy/council_information/jsna/jsna.aspx#overview

Create to regenerate; The recovery movement where people have struggled with mental health and substance use are some really good examples of regeneration https://www.mentalhealth.org.uk/a-to-z/r/recovery

Be agnostic about growth: Now, I’ve proposed increased taxation which requires people to be in work to have the resources to pay which in turn means we need to ensure jobs exist. However, doughnut thinking suggests we value jobs differently so caring/volunteering could/should have greater value then jobs which define existing definitions of a successful economy. As Kate Raworth says: ‘we know full well that we have the know-how, technology, and financial means to end poverty in all its forms should we collectively choose to make that happen’……we are all economists now.

So what…..well, as described above some of this stuff is being implemented or at least thought about already. Why not audit where you are with Kate’s ‘audit’ or better still ask C.Co to give you a hand…….It may give you a fresh perspective. You don’t need to go all misty eyed about the future funding model for health care, you could focus on a service , a pressure or an opportunity?

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