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.’

Tuesday, 11 September 2012

The NHS - new term, new headmaster, same curriculum.

I’m sure that the coalition government has been exceptionally grateful to the Queen, our Olympians, our Paralympians and even US Open tennis champion Andy Murray for a wonderful summer of distraction – helping us to overlook the tricky issues facing the UK.

Well kiddoes – the summer holiday jollies are over and the new term has started. Back to the serious business of the economy, and more specifically for me and my readers – health. This time last year I posted a blog entitled ‘new term, new habits’ and made a request for all those involved with healthcare delivery to do the following: be nice, respect each other’s profession, acknowledge that others don’t know what you know, stop using jargon, make your meetings count, take pride in your environment and think integrated. It was a worthy wish list and when you think about it – all of the above was applied with incredible success to make our Olympic and Paralympic dream a reality.

But speaking of reality - as the children go back to school and we drag our eyes from the TV screen back to our p.c.s - what is in store?

NHS Reform is still happening and it’s no good pretending it’s not real. The new term brings  not only the same day to day challenges of delivering cost effective safe care,  but the NHS must start to get used some of the major changes. Yes – we have a different headmaster, but the curriculum is the same.

I see the only major significance of a new Secretary of State for Health is that now it will be Jeremy Hunt and not Andrew Lansley to face the barrage from the public sector unions and medical professionals as they continue to make their feelings clear.  

So – what I am hoping for this term? I hope that everyone involved with trying to make these reforms work accept that this is now law and whingeing won’t get them anywhere. I hope that the commissioners do the job they are supposed to do and that the balance of power does not rest as heavily on GPs as originally planned. I hope that hospital and community based health professionals have a significant say in patient pathway planning. I hope that the brain drain from Primary Care Trusts is not as bad as I fear it will be and that managers will provide robust leadership. I hope that the general public will understand that healthcare doesn’t come cheap and the NHS cannot pay for everything.

And most of all, I hope the new Headmaster will watch, listen and learn.

Tuesday, 4 September 2012

How will history judge Andrew Lansley?

As predicted, the Secretary of State for Health has been moved out of harm’s way in David Cameron’s government reshuffle.  Also as predicted there is a dearth of wise cracks about Andrew Lansley’s departure and muted celebration among NHS employees at the end of tenure for an unpopular minister.

But there have also been some kinder words – such as the Health Services Journal editor, Alistair McClellan who delivered the veiled compliment ‘…by a long shot – not the worst health sec of modern times..’ 

The Royal College of Nursing have hedged their bets – saying ‘In challenging times, the RCN has not always seen eye to eye with Andrew Lansley on the government’s health reforms. However, we have welcomed the continuous dialogue….’

The BMA's official statement was a little less tactful with 'The appointment of a new health secretary provides a fresh opportunity for doctors and government to work together to improve patient care and deal with the many challenges facing the NHS

And what exactly do I mean by ‘out of harm’s way’? Has the harm already been done? Or is moving Lansley to the new post of Leader of the House of Commons effectively taking him out of the firing line as problems with the Health and Social Care Bill inevitably escalate. He may well appreciate the relative calm of organising the government business in the House as the £20 billion savings target for the NHS becomes reality and the new Health Secretary, Jeremy Hunt sticks his head above the trenches to face heavier, and better targeted fire.

I wonder how the unbiased should view Andrew Lansley’s ten years’ devotion to the cause. And be assured that devoted he has been. Misguided, intransigent, short sighted,  tunnel-visioned – Lansley meant well but got it wrong. He is a politician with ill-conceived strategy who used flawed benchmarks.

I don’t believe that the Health and Social Care Bill will destroy the NHS – there are too many good people within the system to let that happen, but Lansley was the architect of much confusion who handed the mantel of power to, in the main, unwilling recipients as many GPs’ retirement has been hastened. His reforms will probably waste more money than they will save and his unsustainable sound bites outweighed his good ideas.

I wish Andrew Lansley all the best in his new role and who knows how history will ultimately judge him. But for now, he’s the Health Secretary who just didn’t listen.