How the Health Foundation is supporting the NHS in 2015

It’s tough out there – no one needs reminding. Finding a rational way ahead will tax us all (no pun intended).

The first task is to make an accurate diagnosis of the challenges. What’s the detailed anatomy of demand? Do we have enough staff and facilities? What is quality looking like, not just across national dials but across geographies, cohorts of people and health care economies? What is the best measure of productivity, and how does productivity vary across locations, and how much extra is needed to keep the NHS as we know it afloat?

If the answers are not clear, neither is the assessment as to how we got here. Despite the data-rich NHS, finding answers is surprisingly hard and we are far from reaching a common understanding. Yet we could do much better with the information we have.

The second task is to assess potential solutions – from prevention to front line waste-reducing incremental changes, to change across whole health care economies. There seems to be a ready consensus of intelligent avenues to follow and no shortage of ideas – many pithily set out in NHS England’s Five Year Forward View – and being pursued across the country.

Then the most important task of all: how to make change to the extent now needed? There is no shortage of talent, mission and will. Making an intelligent cocktail of policy levers – ‘prods’ on providers – is important and can result in change fast. But what’s your rough estimate as to how much impact these will have across the NHS, relative to what is really needed? 10%? 1%? The obvious point is that central policies cannot deliver the complexity of change the NHS now requires – only those at or near the front line can. And they need a large dose of understanding and injection of support.

What would the support look like? At least three broad types might help…

Support for clinical teams to make quality/productivity/safety improvements, using basic practical Deming-style quality improvement (QI) tools. Not working harder, like modern day Stakhanovites, but making small tests of changes which are measured and then adapted.

This approach works to improve the flow of patients (as our Flow, Cost Quality programme demonstrated), reduce length of stay, improve safety and reduce the frustrating time that busy clinicians spend having to search for notes/equipment/test results, or that patients waste in the NHS. Colonising the front line with these QI skills and giving people the space to make change every day – and the expectation that they should do so – should be a medium-term strategy. Together these changes will add up to something big – radical transformation perhaps.

Next, equipping clinical leaders and middle managers with operational skills. Think of all the simple frustrations we endure as patients because of disordered processes. Again this needs a longer term view to build capability.

Lastly, support to chief executives and their teams to take calculated risks to make cross-provider changes. Change won’t happen if not backed up by policy and leaders who act out the warm words they say.

The fourth task: how to monitor progress? All the above may not help much if we can’t learn what works best and identify the symphony from the cacophony.  Here we need to develop better assessment of what will be complex evolving interventions, using real-time evidence that leaders at the front line can believe and respect. This means robust and new forms of evaluation which exploit existing data but are not confined to the randomised controlled trial.

What then will we at the Health Foundation be doing in 2015 to help with this challenge?

Our new policy and economics teams are attempting clearer diagnoses of the challenges and suggesting solutions, not least new models of care, and the right milieu of national policies to support change. Our Three tests of change for a credible health policy, published today, outlines our policy recommendations for politicians ahead of the general election.

Our improvement team is working with others to build skills at the front line in quality improvement, as well as funding and learning from frontline projects to improve care. This is the biggest area of the Foundation’s investment. For example, our partnership with NHS England to develop 5000 quality improvement fellows across the NHS in England will be a big help.

Our research team will be investing over £4m in new research projects, as well as continuing to develop our knowledge and understanding of how improvement science can help to improve the quality of health care.

Our data analytics team will be testing new methods to assess the progress of adapting service interventions – from new models of care to new payment mechanisms – with innovative approaches to using data.

Finally, we are doing reconnaissance in 2015 to understand what our contribution might be to improving health across the UK with a view to developing a portfolio of grants for 2016 and beyond.

Join us on our journey and keep tabs on opportunities to get involved via our email alerts, newsletter and social media.

Jennifer is Chief Executive of the Health Foundation