After the fire: regrowth and regeneration

‘It’s like after a forest fire; there’s devastation, but also potential for regrowth.’  

This is how one clinician described the effect of the pandemic to me recently, capturing the duelling sentiments of recognition of present realities alongside optimism for future possibilities.  

Emerging data on the present reality for the NHS make for grim reading, with April’s statistics showing 4.7 million people waiting for routine elective care and over 387,000 waiting more than a year in England alone. And as my colleague Anita Charlesworth has described, a starting point of poor health, inequalities and sustained underinvestment in public services makes for a forbidding backdrop to the recovery challenge. 

At the same time, future possibilities for improving services are becoming visible. The pandemic has accelerated innovation, most obviously through new treatments, tests and vaccines for COVID-19.  

That catalytic effect extends also to innovative uses of technology, and creative models of collaboration and service delivery. For example, uptake of online consultations, and integrated health and social care models such as Discharge to Assess have increased rapidly. It’s in innovations such as these that the seeds of sustainable recovery are likely to lie. 

Accelerating service innovation 

I declare an interest in the examples above, as the Health Foundation first funded early experiments in each over 10 years ago.  

The question as we look ahead is how can we accelerate the development and spread of innovations such as these? What else could we do to identify and scale up quality and productivity enhancing innovations, so it doesn’t take a decade and a global pandemic to get valuable ideas into widespread practice? Alongside adequate funding, workforce planning and system reform, there are several active ingredients that could help.  

Exploiting the potential of data and technology 

Advances in the use of data and technology offer significant potential to improve health care. Data can help guide priorities for national and local action, as well as assist in rapidly understanding the impact of changes to care. My data analytics colleagues are leading two major initiatives in this area: the Networked Data Lab, using linked data to generate new insights, and the Improvement Analytics Unit, using robust methods to help policymakers and practitioners rapidly evaluate the impact of interventions. 

Data-driven technologies can also directly support improved quality of care, for example through tools to support earlier detection of disease. They can also enable greater productivity, by reducing time spent on operational tasks such as appointment scheduling.  

Fully exploiting this potential requires leaders able to ask the right questions of data, a skilled analytical workforce, and clinical and managerial teams able to translate insights from data into action. We are partnering with Health Data Research UK on the development of this ‘Learning Health Systems’ approach, including funding demonstration projects through the Better Care Catalyst programme. 

While these technologies offer promise, the full benefits will only come from fitting them successfully with patients’ lives and the work realities of staff, which will often require a redesign of roles and ways of working. This summer we will publish a new report on the challenges and opportunities of putting automation and artificial intelligence into practice effectively. We are also undertaking research to describe the wide array of national initiatives underway in technology and to gather views on how this might be developed. 

Enabling more effective management of change 

However technically brilliant an idea, any change is only as good as its implementation. Over the past 15 years, the Health Foundation has invested £200 million in supporting change at the front line, through applied projects, fellowships and research. 

Our commitment to supporting better management of change continues. We are investing in national assets for improvement, such as the Q Community, now more than 4,250 members strong, which provides a vibrant space for the improvement community to connect, learn, and collaborate. THIS Institute, our collaboration with Cambridge University to develop the evidence base for improvement, has created Thiscovery, a novel approach to enabling wider participation in research, and is delivering several studies to assist the NHS response to the pandemic. We continue to build capability in improving flow across pathways, through the Flow Coaching Academy, and in supporting the NHS to deliver social and economic impact in its community through the Health Anchors Learning Network. 

We also announced in March our investment with the Economic and Social Research Council in our first major improvement initiative in adult social care, the IMPACT Centre at the University of Birmingham. 

Using improvement approaches to support regeneration 

As I argued in a recent blog for the BMJ, this year’s budget left the NHS with significant uncertainty about how the ongoing costs of the pandemic will be met. Even if further funding increases and workforce plans were to be forthcoming, meeting the high levels of demand the NHS now faces would still require the service to innovate rapidly in how it delivers care, including building on the many examples of staff ingenuity and service change seen during the pandemic.  

Findings from a recent Q report, summarised here, strengthen the case for embedding improvement into core ongoing work in health and care services. A continuous improvement approach and mindset will have a significant role to play in supporting services in their recovery from the pandemic.  

This month, we’ve published an updated version of Quality improvement made simple, the original of which has been downloaded over 75,000 times. We have supported the evaluation of one of the NHS’s major improvement initiatives, the partnership of five NHS trusts with the Virginia Mason Institute, which is soon to publish interim findings. We will also be partnering with NHS Providers to raise trust board awareness of how to put in place systematic, organisational-wide approaches to improvement.  

We want to extend this focus on implementation to our work on innovation and technology, and so in May, we will select sites for our Adopting Innovation programme. Building on our 2018 report, The spread challenge, we will be providing support to create engine rooms of innovation and adoption embedded in local health and care systems.  

Later this summer, we will also be publishing a new long read on how improvement approaches including improving flow, technology, skill-mix changes, new care models and supported self-management, can help the NHS meet the productivity challenge ahead. 

Policy enabling change in practice 

Local action will need national support. The government will need to provide significant investment in productivity-enhancing innovation, and in the NHS and social care workforce, with an estimated additional 1 million new staff required by 2033/34. But with the right conditions, like the forest after a fire, the health and care sector will be able to regenerate and thrive again. It will be a process of years, and the forest won’t look the same as it did before; but with thoughtful investment, policy and management choices, there is the potential to develop health and care systems more resilient to shocks, and better able to deliver sustainable, high quality care. 

Will Warburton (@willwarburtonHF) is Director of Improvement at the Health Foundation. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.