Decentralisation of clinical services
Whilst the concept of the decentralisation of health care services (and by this we mean the relocation of centralised clinical services into the community) is not new, there appears to be a dirth of data to support an informed debate as to the merits of it. A report in 2011 titled: ‘Getting out of Hospital‘, published by the Health Foundation(1), summarised their analysis of decentralisation in these terms:
“The conclusions are appropriately cautious, however. The majority of the published evidence fails to contain robust cost information on infrastructure, planning and start-up costs. Furthermore, much of the evidence is based on small, highly [patient] selective pilots making it difficult to make system-wide generalisations for a broader range of patients.”
The authors make the following recommendations:
“Developing a consistent framework for research and analysis, identifying key factors that can be monitored and evaluated across interventions and settings, would help to inform commissioning decisions. A consistent analytical framework for summarising information would support the collection of comparable information that could show how to successfully implement systemic and strategic changes to service provision. “
Establishing a framework for research and analysis is where The Conclude Consultancy has focused its efforts in the mid-term evaluation for a Community Eye Centres (CEC) contract in Leeds. Conclude were appointed to analyse the Approved Quality Provider (AQP) contract from the perspective of the ‘Triple Bottom Line’ (2) – a means for evaluating not just the economic impacts, but the social and environmental impacts too. To establish the foundation for an evaluation framework, The Conclude Consultancy developed a CEC Measurement Protocol that would ensure consistent processing of data and standardised norms for reporting the results. As the primary objective for Conclude’s appointment was to study the environmental impacts of decentralisation, the measurement protocol was developed to analyse the energy and carbon impact of the CEC’s. However the work was also extended to study the impact of space and equipment utilisation, which would inform the economic impacts too.
This latter perspective highlights the need for a framework as advocated by the Health Foundation. It was clear from the analysis that the cost of decentralisation must include the less tangible costs of space and equipment utilisation, as well as other costs such as the carbon tax. This points to the need to establish the evaluation criteria in the planning of decentralisation projects, and to determine what data needs to be managed to enable a proper evaluation (using a measurement protocol) to be conducted. Conclude’s experience mirrors that of the the Health Foundation: the difficulties of obtaining robust data constrained the analysis. Yet despite this, the CEC team now understands what data it needs to manage for the remainder of the contract and how it should analyse the performance of the AQP contract from the perspective of the ‘Triple Bottom Line’.
A Case Study for the project can be accessed here: Decentralisation of Health care services