Martin McShane: Pathways don’t fit

Martin McShaneThe buzz word of late has been “pathways.” I guess that has been brought about by Michael Porter and Elizabeth Teisberg’s article in the Harvard Business Review and their book Redefining Health Care.  The problem with commissioning along pathways, as one of my General Practice colleagues put it so succinctly, is that they don’t fit.

Theoretically  a pathway is a great way of conceptualising health care delivery. Like many good theories it runs into the problem that human beings, irritatingly, don’t fit neatly into the boxes provided for them.  As the GP pointed out to me, “I don’t see a patient with diabetes, or heat failure, or arthritis, I see a patient with diabetes and heart failure and arthritis.”  The GPs tell me that the hardest condition they have to deal with day in day out is “frailty.”  The shift in demographics and disease pattern means that long term conditions are consuming the best part of health care spend but not as individual conditions.  Long term conditions like working as a team.  This is backed up by published research which found 98% of patients over the age of 65 had multiple morbidities.

So, taking this intelligence on board we are working with the practices, community services, social care and the specialist services to try and implement a service for FOPs.  Since long term conditions like working as a team we reason you need a team approach to tackle their challenges.  Our modern day FOPs are “frail older people.” In 2009 patients over the age of 85 accounted for 17% of emergency admissions and took over 27% of occupied bed days in our major acute trust.

Being a fop is back in fashion but this time it is not about foolish men over concerned with their appearances and clothes but a serious problem which needs serious attention and single disease pathways just don’t fit.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive  committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.