The paradox of faster progress? It takes time…

4 June 2019

Almost everyone agrees the NHS needs to speed up progress to be sustainable. On 23 May more than 200 people gathered at our annual event to explore 'how' and tried to resist the big temptation just to 'polish the problems'.

What struck me at this event was how wide-ranging the conversations were – and not just around how health services might become more efficient and improve quality of care, or how the NHS Long Term Plan might be implemented. Debate also covered the contribution of the NHS to improving health and wellbeing, what makes for successful collaboration across traditional sectors, how the energy and motivation of patients might be put to better use, and what needs to happen to improve the use of data and spread of technology.

Ingredients for faster progress

Simon Stevens, Chief Executive of NHS England, opened the day taking the opportunity to highlight the NHS’s contribution to improving population health. His examples included supporting people in employment, the NHS being an 'anchor institution' (particularly in deprived communities) and taking steps to improve air quality – to reduce environmental impact, but also to reduce avoidable ill health and death from respiratory disease.

The Chancellor recently remarked that the public finances had been returned to health (annual borrowing down from 10% GDP 10 years ago to 1% today) and 'for the first time in a decade this country has choices'. So a question to Simon was: how would he choose to spend funds, outside of the NHS, to increase population health? His response unsurprisingly focused mainly on elements of the budget still to be settled in a forthcoming Spending Review – public health, capital investment, workforce and social care. The contribution of the NHS, public health and wider public sector spending to the economy and societal wellbeing as part of 'inclusive growth' is being increasingly recognised. We are seeing it move up the policy agenda not just within the Health Foundation or the UK, but across OECD member countries.

Breaking the boundaries of health care

Simon’s comments set a tone for the day and prompted further discussion about the wider factors that influence our health. Kieron Boyle, Chief Executive of Guy’s and St Thomas’ Charity, presented on the NHS’s contribution to ‘place' and the creative approach they are taking in Lambeth and Southwark. Our very own Dominique Allwood spoke about the NHS as an anchor institution, drawing on examples across England (in employment, procurement, building community partnerships and tackling climate change, for example). Further vivid examples from Care City East London, Leeds Teaching Hospitals NHS Trust and internationally via the World Health Organisation, prompted three basic reflections.

Firstly, that enough staff in the NHS are motivated to make a wider contribution. Secondly, there is no shortage of creative ideas. And thirdly, collaboration is happening.

But the challenges are equally clear, including: the time, effort and sheer diplomacy required for effective collaboration; the lack of data analysis on how best to target efforts and measure impact in a transparent way; and the need to shape priorities with the public and patients. The latter two were well demonstrated. For example, we heard about 'Born in Bradford' – a cohort study of young people led by Professor John Wright from Bradford Institute for Health Research – an initiative using data very creatively. And the Health Foundation’s Young people’s future health inquiry, which was entirely shaped by the priorities young people themselves identified.

Putting people at the centre of quality improvement

Taking a pragmatic, people-centric approach to improving quality of care has significant expert support. Leaders of cross-boundary programmes, such as Dr Mark Hamilton, who is Clinical Director at Surrey Heartland Integrated Care System Academy, are clear that it all comes down to people. Good management, stability and a systematic approach to improving care are all vital (as demonstrated by the case studies in our recent report, The improvement journey).

And our panellists on this topic showed what can be done, with a fair wind, if only some risk would be taken: for instance, a big improvement in care once prescribed drugs were sorted out for care home residents (the project led by Dr Wasim Baqir of NHS England is now being implemented nationally), and much better treatment and use of emergency medicine by mental health patients thanks to the leadership of Dr Barbara Cleaver at Imperial College Healthcare NHS Trust.

Looking to the future

We also explored the emergence of data and technology to speed up change. A big focus of debate was on the prospects for automation, how professionals can be helped to embrace assistive technologies that will transform their roles, and how to harness data better – all of which will be covered in a forthcoming Health Foundation programme on Shaping Health Futures.

For a dose of realism, the ten years it has taken for Dr Shanti Vijayaraghavan at Barts Health NHS Trust to implement diabetes outpatient consultations by Skype is telling. Now however, Shanti is helping trusts in Oxford, Norfolk and Northumbria to do similar but in different specialties. This proves that much is possible, very little is simple, time is needed, and there is no substitute for careful, experienced management to engage staff and make progress.

And it is these final reflections that really chime against the powerful 'disruptive pace and scale' narrative that is still ubiquitous. A narrative rooted in the conviction that competitive bite, and now the disruption of technology, might speed up improvement. From the collection of health care industry leaders who joined us at the event, and who have had a significant role in improving (or evaluating) services and health at a local level, I suspect there may now be a critical mass to challenge this narrative.

Dr Jennifer Dixon (@JenniferTHF) is Chief Executive at the Health Foundation.

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