The Changing NHS

 

I've just finished working on a set of strategic scenarios that describe four 'edge of plausibility' possible futures for Health and Wellbeing systems. The work was commissioned by NHS North West and the detailed scenarios can be downloaded from their website.

The scenarios are titled; Corporate Cures, Community Cures, Shopping for Health and Living for Health. They have been developed, over the course of 12 months, involving nearly 400 NHS managers and clinicians, local authority senior officers and Councillors, MPs, 3^rd sector leaders, private healthcare leaders etc.

The rationale for the work, basically, is that NHS strategy making is sometimes too narrowly-focused and short-term in nature. Senior leaders (national and local) often assume that the NHS is sufficiently powerful to exert a dominant influence on its’ strategic operating environment. Unfortunately this assumption is proving less likely as a number of fundamental drivers bring stronger pressures to bear over the next 10-15 years. These drivers include:

1. Approaching the limits of the welfare state (expressed through a more solid public consensus about the ‘tax take ceiling’)
2. An explosion of new treatment and diagnostic possibilities
3. An ageing population; and
4. Increasingly sophisticated and demanding forms of consumerism

Building and using strategic scenarios is one way of helping leaders explore possible ways of coping/thriving in the light of these drivers. Hopefully NHS organisations can use the scenarios to help them improve the far-sightedness of their local strategies. Essentially by:

1) mentally immersing 'strategists' in the 4 future ‘worlds’ that depict, in differing ways, how English Healthcare and Wellbeing systems might evolve through to 2020; and

2) subsequently ‘returning to the present’ to discover a) new or sharper insights into what strategies might be appropriate over the next few years or b) new insights into how robust existing strategic intent is and what conditions might trigger it being re-thought. 

Anyway, we will see, as local Trusts and PCTs start to use them. 

nhs

strategic scenarios

I thought you might be interested in seeing this very comprehensive comparative study of healthcare performance across 6 countries – USA, Australia, Canada, Germany, New Zealand and United Kingdom. The study was done by The Commonwealth Fund – which is a highly regarded private research foundation in the States.

Drawn from 3 surveys that together cover the views of over 20,000 patients and physicians, the study has about 120 comparative ‘charts’ of data, covering lots of performance issues across 6 broad categories:

1. Quality of Care
2. Access to Care
3. Efficiency of Health System
4. Equity of Health System
5. Ability to Ensure Long, Healthy and Productive Lives
6. Views of the Health Care System: Physicians and Patients

You can see all 120 ‘charts’ here  From a quick scan, a few of the things that struck me about the UK system are:

1. We make much more use of nurses in routine care management of sicker adults (Chart 15)
2. We make much more use of multidisciplinary teams in primary care (Chart 18)
3. We score relatively poorly in measures concerning Patient Centered Care (Charts 39-44)
4. We are much more likely to set targets for clinical performance (Chart 46)
5. We can get much speedier access to a doctor than people living in the USA (Chart 56)
6. We have much better out of hours access than the USA (Chart 58)
7. If you have above average income then you are much less likely to have your blood pressure checked than someone with below average income, whilst the reverse is true in the States (Chart 105).

What ‘jumps out’ at you from flicking through these charts?

P. S. Many thanks to Paul Levy for drawing this data to my attention in his excellent blog - Running a Hospital

Steve

nhs

clinical performance

uk healthcare

It's 4am on a Sunday morning and my head is spinning around with questions. Usually I just 'bat these around' whilst trying not to wake my wife, but this morning she's woken up and kicked me out of bed, so here I am. 

Why should I suffer alone!

1. If Blairism was about the realisation that the vast majority of British people are now middle class why should Brownism be any different?
2. It's not a middle class elite it's a middle class majority
3. Is it possible to have a health and wellbeing system that operates in ways that delights the majority and  protects the most vulnerable or disempowered members of society from the consequences of making poor decisions? 
4. Why is the NHS (by which I mean the majority of people employed by it) so fearful of consumerism?
5. Defensive producer interests are so often strongly aligned with arguments about needing to sustain a system designed to protect the most vulnerable in society. Will the most vulnerable and needy ever become the most powerful voices for radical change? If this happened then 'the genie really would be out of the bottle' 
6. We don't have a National Food Service so why do we need a National Health Service?

What am I talking about. I'm as middle class as they come and I don't even know my Cholesterol count or how to find it out!

Steve

nhs

change management

Writing here last week about recent UK attempts to amplify consumer pressure on healthcare providers reminded me of an international seminar I attended in 2000 whilst working for a health care learning network called ODPN . A group of healthcare provider Chief Executives from the UK, USA, Spain, Germany and Australia spent a few days together in Spain, exploring the implications for them of the rise of the informed healthcare consumer.

Without getting bogged down in detail, the starting point was a simple conceptual framework (above) that depicted three key influences and pressures that all healthcare organisations face, to varying degrees, at any point in time.

The assumption being that the system was increasingly likely to become unstable and this, in turn, presented CEOs, as leaders of healthcare providers with some opportunities. For example they could choose, at certain times, to see themselves as:

i) Leader as Maintainer – helping their local system to remain as stable as possible, by seeking to keep these often competing sets of pressures in balance as much as possible. (Most of the the UK and Spanish CEOs felt this was their natural territory);

ii) Leader as Agent - actively seeking to bring about a new dynamic by encouraging an accumulation of power to points A and/or B and/or C. (Most appealing to the CEOs of Mental Health providers who supported the growth of pressure point B).

iii) Leader as Systems Architect – (represented below) encouraging alliances between various pressure points. For example, by encouraging the formation of an alliance between a national consumer group and local clinicians – where both groups (and the provider organisation itself) wants to see funders agree to pay for a new treatment modality. (The most appealing role for majority of USA CEOs).

Despite being quite simple, this framework served as a very useful reference point to help get conversations started. How might a provider CEO’s role within a system ebb and flow as healthcare consumerism growths in strength and technological possibilities become more available? This is sure to become a much bigger question - sometime soon.

Steve

www.stevepashley.co.uk