Look to the future

As the shock and awe of Brexit gives way to pragmatism, now is a good time to let you know some of the Health Foundation’s contribution to the coming years of the NHS and our focus on supporting improvement to the quality of patient care.

First in line is something I can’t say too much about yet, but circumstances demand a reference. The Health Foundation is founding a new network for European health leaders, along with our colleagues in two other independent foundations – Bosch Stiftung in Germany, and Careum in Switzerland. The objective? To foster greater learning and mutual understanding across leaders working in different European health systems, and to learn about global solutions to the challenges we all face. Watch this space for further announcements.

Next, whatever the impact of Brexit on the economy, the coming years look far rockier than they have done, even as recently as the NHS Confederation’s annual conference at which our very own Anita Charlesworth gave her now familiar ‘angel of death’ plenary presentation about the state of NHS (and social care) finances in England and the hard road ahead. Fittingly, Anita’s talk was orchestrated with heavy claps of thunder, perhaps matched only by the storms raging on (and after) 23 June. If future economics demand that the thumbscrews are tightened – and not only if there really is ‘no more money’ – then efficiency and productivity have to be very seriously ramped up as part of the solution, and to avoid the dreaded ‘r’ word.

In one of the largest, most complex and resource-intensive sectors in the UK, if not Europe, this must be the hardest task facing any set of managers in the country. Given the talent and intrinsic motivation of national and local leaders across the NHS, and in particular those on the front line – not to mention the limp productivity elsewhere in the wider economy – the government and devolved administrations should show appropriate humility in the face of the task. They must favour ‘thinking support’ not ‘unthinking attack’ in the months ahead, avoiding glib solutions. And, just as importantly, everyone will need to be as locked on to managing the quality of care as the money, lest safety slips backwards.

So what is the Foundation doing to help?

You will know we give out the bulk of our circa £30m spend per annum to support improvement and innovation projects in front-line care, skill up potential leaders, and fund underpinning research. Have a look at some of this, and apply for some opportunities.

But I want to tell you about some bigger new initiatives we are cooking, all to help speed intelligent change. Having spent more than 20 years analysing policy and major service initiatives in the NHS and internationally, I note how often policymakers do not have a full view of the impact of current and past policies, and how little useable information is available to help those managing local initiatives. This is compounded because the research and development community has not been close enough to either group to understand their needs and help design effective solutions.

So, some help. First, partnering with NHS England we are setting up an Improvement Analytics Unit. Focusing on top priority initiatives such as the Vanguards, this unit is trialling rapid quantitative feedback to a small number of sites in England on progress on quality using the latest analytical methods – Adam Steventon, the Foundation’s Director of Data Analytics, has more details. Rapid feedback to sites will help them understand what is happening and why, to help regular course correction. Independent feedback in this way to NHS England will also help identify what else can be done at national level to accelerate progress. There will be an annual independent analysis published by the Foundation to show impact to date using a set of quantitative metrics. This is the first initiative of this type in the UK and could provide a significant addition to the wider work in NHS England to assess improvement and support learning.

Second, we are founding an improvement research institute and are currently inviting expressions of interest for establishing and hosting it. For almost a decade the Health Foundation has funded empirical and theoretical research on how to make improvements in the delivery of health services, and opportunities for people to develop their skills in this area. There have been notable successes. For example ground-breaking work into patient safety and how it could be improved has influenced national policy and local practice. And analysis of flow has helped people delivering care design more efficient, effective and safer clinical pathways and spawned several major flow initiatives. We have funded 14 Improvement Science Fellows. The first four Fellows we funded have secured £23m in additional funding for their organisations and produced 54 academic papers, while six awards have been won and four books have been published.

We believe the field now is at a stage for independent leadership to develop a strong network of academics working hand in glove with people delivering and receiving services to make improvements faster. The new improvement research institute is the first of its type in the UK, and will be rooted in a UK university but with global connections and learning from other health systems and other industries. The aim is to bring research on service delivery up close and personal to those trying to make change in health care. For more information, including the application process, see here.

Third, no one should doubt the potential of the phenomenal intrinsic motivation of people working on the front line to make changes. While there is terrific talent, if more people had the skills to make change the NHS would be an even better place. Will Warburton, our Director of Improvement, describes what we are doing to build skills and knowledge in this area . Ambitiously we are developing Q, a network of people working to improve services, through linking people to share ideas and expertise, identifying resources to help them, and making it easier for them to collaborate on collective projects. This is a partnership between the Health Foundation and NHS Improvement and over the coming years ‘Q’ aims to connect thousands of people. This is potential we want to boost.

Finally for those who weren’t at the NHS Confederation conference, you missed our giant shoe box heralding ‘A Mile in My Shoes’.  Our focus is empathy and understanding of others: literally don another’s shoes and walk a mile while listening to an audio recording they have made of an aspect of their life. It’s the brilliant idea of the Empathy Museum and we collected some moving examples from the health and social care sector. People can hear from and be connected to people with a range of roles, including front-line jobs like pharmacist and GP, to some less visible positions such as finance manager, HR manager and porter. For an opportunity to take part, visit us at the Health and Care Innovation Expo in Manchester in September. Or after Brexit perhaps we should think of using this technique to help link metro elites to the lives of people in Sunderland, Thurrock, or the Welsh valleys. This is going to run and run…

Jennifer Dixon is Chief Executive of the Health Foundation.