Tuesday, 25 September 2012

What does innovation mean for the NHS?

One of the things I love about twitter is the way that random tweets can spark a thought process that leads us to look at things with an alternative eye and challenges the hitherto underutilised recesses of my mind.

The other day I noticed that Clare Gerada, Chair of the Royal College of General Practitioners tweeted ‘Can someone give me a clear definition of innovation in the NHS’?

I then had the luxury of a three hour train journey to Liverpool to contemplate this conundrum. Two diametrically opposite quotations sprang to mind. The first by Bill Gates 'Never before in history has innovation offered promise of so much to so many in so short a time' celebrates newness and change in all its glory. The second, by Coco Chanel 'Innovation! One cannot be forever innovating. I want to create classics'  honours the tried and tested.

Of course both of these quotes are applicable to the NHS in the 21st Century and maybe an appropriate combination of the old and the new is the Utopian vision we should aspire to achieve. Innovation in any context can be the excuse for a multitude of sins or a cacophony of excellence, but here is my personal view of where innovation should sit within the context of an NHS struggling with reform.

Innovation should NOT be…
The new buzz word! Yes the irony does not escape me. I have recently written a piece in Health Insurance magazine pleading for providers to stop using the ‘I’ word unless they really are coming up with something new. Whether it’s products, services, care pathways or medical techniques, please don’t say they are innovative unless they really are. The rehash and repackaging of old ideas achieves little and can cost much.
Change for change’s sake: Secretary of State for Health (whoever you are) please note. Change, such as radical restructure, rebranding or even just changing titles, must comply with measurable governance and provide a real opportunity for improvement. Change should not have a political expediency or be created on the basis of a need for heightened publicity.
Re-inventing the wheel: Same job, different title. Same function, different department. GP commissioners and disbanding  PCT’s. Enough said.

Innovation in the NHS SHOULD be:
Ways of working smarter: Needed at all stages of service delivery. This is innovation in the improved outcomes sense of the word– streamlining, service improvement, efficient pathway mapping, resource planning and possibly most important of all – robust leadership.
Looking at sustainable means of funding care: The public purse is not like the fabled magic rice bowl that refills on demand. Public private partnerships, patient contribution, increased taxation, improved use of voluntary resources – all must be considered to meet growing cost of healthcare.
Creating a system to not only educate the public but to generate changes in behaviour: The western world seems to be on a path of self-destruction with unbelievably unhealthy habits, from smoking to drinking, over indulgence and lack of exercise. Changing this self-harming way of life would not only be innovative, it would prolong healthy life and save the NHS billions.
Research and Development: Whether this is funded by commercial enterprise, charities or academic institutions – the unimaginable has already been achieved through innovation within the NHS and through strategic partnerships. Reform and cost cutting must not be allowed to halt this progress.

A crystal clear definition of innovation in the NHS? Not possible. But I can have a stab at defining the golden rule that should apply to all such innovation. It works for clinical research, and applies to basic management techniques, service redesign and lean consulting. What is the true cost of a planned innovation (in financial and human terms) and what is the potential, measurable benefit? Is there sufficient evidence or theory to justify the risk associated with the innovation (clinical, emotional, physical or fiscal). If these questions produce unsatisfactory answers then you should only proceed, if at all, with caution.

And one last quotation – accredited to ‘anon’  perhaps provides the closest to crystal clear I can manage..

‘Innovation is not the same as reform.’


Rob Dickman said...

I think the original question - ‘Can someone give me a clear definition of innovation in the NHS’? - hints at thinking on some higher plane but is actually somewhat nonsensical. Why do we need a definition?

It is extremely vague what it is she means? We can easily define what innovation is - it is about introducing something new or different (which, incidentally COULD include reform!) and there have been many examples of this over the decades that the NHS has been in existence. For example, we didn't rid the nation of various diseases by following the same path as before so I'm struggling to understand what Ms Gerada is asking?

Of course, given previous form, it is probably a veiled criticism about the NHS reforms. Reform is a consequence of government being faced with rising costs and growing demand, so they are constantly searching for methods of delivering higher productivity in healthcare, or, put more simply, ways of getting higher quality without increasing expenditure.

Interestingly, it is GPs as a group that contribute significantly towards the rise in NHS costs. A big problem is the huge amount of over-prescribing that goes on. I put some stark figures as a reply to one of your previous blogs and will repeat them here:

In 2010, nearly 927 million prescription items were dispensed; this is a 4.6 per cent rise on 2009 AND A 67.9 PER CENT RISE ON 2000.

An average of 17.8 prescription items were dispensed per head of the population in 2010; compared to 17.1 in 2009 and 11.2 in 2000.

I imagine these fiures will rise again for 2011 and 2012. So what does this tell us? I think it tells us two things:

1. The uncomfortable truth is people these days want a pill for every ill and are prepared to ship up at the surgery at the drop of a hat to get what they want. In turn, GPs dole out what their patients want because it is very often less hassle to them than standing by what is clinically correct.

2. This practice of giving the patient what they want creates a reliance on the system (and in particular the GP) that to me is unhealthy (excuse the pun!). And it costs us a great deal of money. For example, prescription charge exemption means that nearly 90% of all prescribed medicines are dispensed free due to condition-specific and low income exemptions, which obviously affects the yield that goes towards offsetting the drugs bill.

Further, the pharmacist is paid per item on a script so in a world where GPs over-prescribe and the state picks up the tab for nearly 90% of prescriptions, there will always be a serious funding issue.

Returning to the original question, I'd say let's see some "innovation" in primary care - and in particular, prescribing practice!

Post a Comment