Recently I had the opportunity to speak with two directors from Britain’s National Health Service. The two questions I asked addressed what they had found worked well and what had worked poorly in attempts to control costs to the system and address human resource issues.

The first thing mentioned was a program that allowed patients to describe and create a plan for their well-being. Patients were asked what would help keep them well and out of hospital. They received assistance in creating a plan that government would fund them directly. They claimed great success with this plan in keeping people out of hospital and that when patients managed the funds provided to them, most did very well.

The most important aspect to reach success with this program was to acknowledge that each patient was different and had unique needs that the individual knew best. Depending on the medical and social problems of the patient, an amount is calculated and given to the patient to manage.

The second most important aspect to this program was to integrate the medical and social care of the patient so that different streams of care begin to work together instead of separately with better alignment with the patient’s needs.

For example, a patient with diabetes, heart disease and related circulatory problems was given 18,000 British pounds for one year to manage their out patient medical needs and activities of daily living at home. The patient hired a helper who did shopping and assisted them in their home.

This program is meeting with success and patient need drives the process of integrating medical and social needs with direct funding to the patient. Considering that in-patient hospital stays are very expensive, funding to the patient to maintain themselves outside of institutions makes sense. When asked if problems associated with mismanagement of these patient directed programs was occurring, for instance patients using the monies for unnecessary items, the answer was no.

What has not worked well according to these two directors is attempting to have community “matrons”, nurses integrated with general practitioners, to provide more primary care in the community. In their opinion, the interface “just did not work”. However, “specialist” nurses who work alongside specialists to streamline the process of patients’ visits has worked well. There was also success using GPs with some specialist training who would provide services at close to a specialist level in one medical area with specialist back-up.

While Canada is predicted to be short between 78,000 and 110,000 nurses in coming years, Britain has a surplus of nurses according to the two NHS directors with whom I spoke. Recognizing the human resources issues within our own country must be married with the knowledge of the resources of other countries. It may be less than ethical to actively recruit health care professionals from countries where there are shortages but quite acceptable to actively recruit from global areas with surpluses.

Knowledge of how countries like Britain are managing their health care systems is useful for Canada, both in learning from what has worked well but also from what hasn’t. A more widespread meeting of global health care minds could help expedite solutions to address the pending crises in both chronic and acute care.