What can England teach us about changing healthcare? Final version of the presentation

A16/B16

What can England teach
us about changing
healthcare?
Helen Bevan
@HelenBevan

Steve Fairman

@SteveFairman1
Crystal Ballroom, Salon A-C
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS

Why might this be useful?
• This isn’t “how to do it” “the best way to do it” or
“we are perfect”
• Understanding some factors and levers that help or
hinder transformational change of a large health
system
• Strategy at system level versus frontline reality
• Case study of “discontinuous innovation”


The English NHS: facts and figures

• Provides comprehensive healthcare to 51
million people
• Funded by direct tax
• It’s free at the point of
delivery
• Virtually EVERYONE
uses it

at
h
W

ta
ri
B


lo
in

s
ve

The NHS is highly valued by
the public – we love it!

Source: Ipsos Mori 2013


If there was one thing that the British people took from
the [World War II] experience, it was a health service
free at the point of use......
And no government of any stripe has dared to try to take
it away from us since.....
Andrew Marr

History of Modern Britain


The British
people
have the NHS
in place of
fear
Aneurin Bevan
Founder of the NHS


The NHS belongs to the people
It is there to improve our health and well-being, supporting
us to keep mentally and physically well, to get better when
we are ill and, when we cannot fully recover, to stay as well
as we can to the end of our lives. It works at the limits of
science – bringing the highest levels of human knowledge
and skill to save lives and improve health. It touches our lives
at times of basic human need, when care and compassion
are what matter most


Patients have a legal right to:
• Access to health services
• Nationally approved treatments, drugs and
programmes
• Respect, consent and confidentiality
• Informed choice
• Involvement in their healthcare and in the
NHS
• Complain and to have that complaint
redressed

Populations served by British
health systems

(as a % of total population of Great Britain)

ENGLAND

SCOTLAND

84%
51,446,000
people

Source: The Times August 2009

8%
5,169,000
people

WALES


5%
2,993,000
people

NORTHERN
IRELAND

3%
1,775,000
people

What do we know about how our NHS is
performing?

Some great news!

16


17 NHS | Presentation to [XXXX Company] | [Type Date]


What do we know about how our NHS is
performing?

Some less great news!

20


Challenges facing the NHS
today

Future pressures

• Improving outcomes against the
NHS Outcomes Framework

• Ageing population and rising birth
rate

• Significant inequalities in health and
life expectancy

• Increasing burden of disease – e.g.
by 2035 46% expected to be obese
with 550,000 extra cases of diabetes

• NHS performance on certain
diseases lags behind the rest of
Europe

• Patient and public expectations rising

• Burden of long term conditions
increasing

• ‘Flat real’ financial settlements
expected (i.e. only in line with
general price inflation)

• Demands on hospitals, emergency
admissions and readmissions rising

• Costs expected to keep increasing
with new and more technology

• Patient experience is too variable

• NHS productivity difficult to increase
– grew only 0.4% between 1995 and
2010

• Unacceptable safety failures

25 @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS

We could adopt this view…

26


“Be ambitious – you can’t
take two steps over a gap”
David Lloyd George

The role of NHS England
• To allocate resources (£63.4bn in 2013/14) to clinical
commissioning groups (CCGs)
• To support CCGs to commission services on behalf of
their patients (according to evidence-based quality
standards)
• To have direct responsibility (and a £24.7bn budget in
2013/14) for commissioning services:
• primary care (£11.1bn);
• military and prison health services;
• high secure psychiatric services; and
• specialised services (£12.0bn).
28


The role of NHS England (2)
• To create the conditions for value for taxpayers and
turn their money into good clinical outcomes through
strong and well-directed commissioners
• To ensure that everything that NHS England does:
• contributes to continually improving outcomes;
• has been clinically-led;
• promotes equality and supports a reduction in health
inequalities;
• is informed by the needs, views and wishes of
patients and the public; and
• promotes innovation and puts research into practice.
29


“What do you mean, you don’t have real
authority, you only have influence?”

30


The history of the NHS in a triangle…
QUALITY
STANDARDS

TENSION

MONEY
31


ENTITLEMENT

NHS England and transformational change
All our work on the ‘Case for Change’, the ‘Call to
Action’ and further work to come, must be:
•Based on clinical arguments about improving
outcomes
•Underpinned by a sound evidence base
•An integral part of every local plan
•Something that appeals to both the head and the
heart…
32


The NHS
Change
Model

www.nhschangemodel.nhs.uk

What do we need to do?
1.
2.
3.
4.
5.
6.
7.
8.

Understand the scale of the issue
Work with patients and be transparent
Shift public expectations
Shift from the current clinical model
(Primary/Community/Secondary….Integrated)
Be relentless on efficiency
Get the incentives right
Find, understand and implement best practice
Encourage innovation

34


1. Understand the scale of the issue

35


The Gap…

36


Why do we have a growing financial
challenge?
Because the equation…

Demographics + Patient/Public
Expectations + Quality
Money
…doesn’t work unless we have transformational
change to the current way of delivering health care

The Dependency Ratio is rising alarmingly

38


2. Work with patients and be transparent
AND

3. Shift public expectations

39


A Call to Action

Preserving the values that underpin a universal health
service, free at the point of use, will mean fundamental
changes to how we deliver and use health care services.
This is NOT about:
• Privatising the NHS
• Charging for services
• Restricting access

What are the engagement themes?

Current challenges
We know there is
more to do and
recommendations for
improvement already
exist

What the people we serve want….
My goals/outcomes

Communication

Person centred coordinated
care
Emergencies

Transitions

“My care is planned with people
who work together to understand
me and my carer(s), put me in
control, co-ordinate and deliver
services to achieve my best
outcomes”

Care planning

Information

Decision-making

8 high impact interventions
• Early diagnosis
• Primary care referrals and prescribing
• Self-help: patient-carer communities
• Telehealth/telecare
• Case management and coordinated care
• Mental health
• Dementia pathway
• Palliative care
45

4. Shift from the current clinical model

46


Why working across organisational
boundaries is important

The core area
for effective
integrated
care

5. Be relentless on efficiency

49


The Magic Box

“Clinical
Development”

Cost

“Drift”

“Cuts”

Reduced hospitalisation
Standardisation
Technology / innovation
Time saving
Reducing clinical error
Waste reduction

Improved quality
With thanks to Jim Easton

6. Get the incentives right

51


7. Find, understand and implement best
practice
AND

8. Encourage innovation

53


The Academic Health Science Networks

54


Core objectives for
Aims of NHS EnglandAcademic Health
Science Networks

1. Focus

on the needs of patients and local
populations
2. Build a culture of partnership and collaboration
3. Speed up adoption of innovation into practice to
improve clinical outcomes and patient experience
4. Create wealth through co-development, testing,
evaluation and early adoption and spread of new
products and services

56


John Kotter: “Accelerate!”
• We won’t create big change through
hierarchy on its own
• We need hierarchy AND network
• Many change agents, not just the usual few
• Changing our mindset
• From “have to” to “want to”

• Head and heart, not just head

and
@helenbevan
@HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents

The largest simultaneous improvement
initiative in the history of the NHS

@helenbevan
@HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents

It started with a tweet!
Trainee doctors and
improvement leaders
started to talk about
how they could build a
social movement to
improve care
Damian Roland
Stuart Sutton
Helen Bevan
Source: @NHSChangeDay
@helenbevan

A 189,000 pledge mountain!

@helenbevan

60

Source: @NHSChangeDay

People took action all over the country

@helenbevan

Probably the only
winner of a global
challenge to
develop leaders
in the corporate
world that names
Saul Alinsky and
Marshall Ganz as
major influencers

@helenbevan

Change Day 2013 was an extraordinary moment in the history of
the NHS. It taught us that large-scale improvement is possible in the
NHS and that the best way to do it is through collective
commitment, action and by keeping it simple.
@helenbevan

3rd March 2014
www.changeday.nhs.uk

@helenbevan

....the last era of management was about
how much performance we could extract
from people
.....the next is all about how much
humanity we can inspire
Dov Speidman

@HelenBevan

What can England teach us about changing healthcare? Final version of the presentation

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