The Health Foundation's responses to the NHS Future Forum

Date: October 2011

Downloads:

Background

The Government asked the NHS Future Forum to start a new phase of conversations with patients, service users and professionals following its listening exercise in April/May 2011 on the proposals to modernise the NHS.

It has been asked to provide independent advice on four themes:

Information: how to harness information to improve health, care and wellbeing, including how information can empower patients.
Education and training: how to develop the healthcare workforce to deliver world-class healthcare.
Integrated care: how to ensure the Government’s modernisation programme leads to better integration of services around people’s needs
The public’s health: how to ensure the public’s health remains at the heart of the NHS.

The Health Foundation is responding on three themes: information, education and training and integrated care (to follow). You can download the full responses using the links above or read the summaries below.

The Health Foundation's response on the information review

The Health Foundation believes that the appropriate collection of information and the effective communication and use of information can play a vital role in improving the quality of healthcare. In our response we draw on the learning from both our research and improvement programmes, with a focus on the practicalities of implementing the government’s vision of making information more accessible and appropriate to support improvements in healthcare.

Much of our response is grounded in our improvement initiatives and evidence reviews relating to information to support people with long term conditions, information to support people making choices between different types of treatment and access to personal health records. The response covers the following issues:

How can we ensure information is available that enables people to take more control of their own care and enable shared decision making?
How can we open up access to information and support people to use it?
How can cultural and behavioural change be fostered to stimulate collection and use of data among professionals?
How can we ensure that information supports improved care (for example, commissioning, research, clinical audit, public health) while protecting patient confidentiality?

Health Foundation's response on education and training

We welcome the Future Forum highlighting the importance of clinical staff possessing a high level of technical knowledge, practical skills and humanity. However, we are concerned that there is little or no shared understanding about the kinds of knowledge and skills clinical staff need to be able to deliver the highest quality of care and to strive to improve care. For this reason, our submission focuses on the question: How can we ensure that education and training in the new system is flexible and fit-for-purpose?

Our response covers the following areas, which we think should be part of the education and training agenda for healthcare professionals:

improvement science,
involving patients in their own care and treatment
and patient safety.

It makes the following recommendations:

The following should be incorporate into the core body of knowledge that is required by doctors, particularly during their undergraduate and post-registration training:
- Improvement science
- Involving patients in their own care and treatment
- Patient safety
The lack of expertise amongst those educating healthcare professionals about improving quality should be addressed.
Professional bodies and the GMC explore how the process of revalidation for doctors can be used to promote learning about improvement science, shared decision making and self management amongst fully qualified doctors. This will require skills for information access, use and support to become an explicit part of Good Medical Practice which underpins the proposals for revalidation.
Patients should be involved in the design and deliver of training for healthcare professionals.
There are a number of existing training programmes, in patient safety and in involving patients in their care and treatment which could be replicated now. The most successful of these programmes are multi disciplinary and involve patients.
Organisations must invest in their capacity and capability to support their staff to learn about improvement.

Health Foundation's response on integrated care:

Integration in healthcare means different things to different people. It can range from pooling budgets, merging organisations to clinical networks operating in a coordinated way. Our submission focuses on front line health care delivery and how it can be changed to provide a more integrated service for patients. In part this is because our work to date has focused on this clinical co-ordination dimension of service integration and partly because we think that the integration of structures is of secondary importance and should be guided by the actual impact on the care that patients experience.

Our response is structured around the six questions posed for this Future Forum theme, drawing predominantly on our recent evidence review ‘Does clinical co-ordination improve quality and save money?’ by Dr John Ovretveit . The summary and full report can be found here:

Does clinical coordination improve quality and save money

Key recommendations

We should focus on improving how care is integrated for those people who are at risk of being hospitalised and for those people whose use of healthcare could be reduced by better co-ordination of their care: for example those with long term conditions.
Action should be taken to address the risks to integration posed by the introduction through the current reforms of an increased number of payors for different aspects of healthcare.
Irrespective of the extent of competition between providers within the health service, greater attention should be given to improving the connections / interfaces between services. This is where a lot of the harm and waste occurs and when providers change this has a knock on impact on other parts of the healthcare system that is currently insufficiently understood and managed.
Innovation should be balanced with proper support for implementation and adoption. Our analysis has shown that there are already many proven ways to improve integration that are yet to be adopted on a large scale and getting the implementation process right is critical to success.