@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
A16/B16What 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
• Unintended consequences and failures (and there are plenty) as well as successes
• Strategy at system level versus frontline reality• Case study of “discontinuous innovation”
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The English NHS: facts and figures• Provides comprehensive healthcare to 54
million people• Funded by direct tax• It’s free• Virtually EVERYONE uses it• There is lots of patient choice
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
What Britain loves
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The NHS is highly valued by the public – we love it!
Source: Ipsos Mori 2013
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The British peoplehave the NHSin place of fearAneurin BevanFounder of the NHS
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
Populations served by British health systems
(as a % of total population of Great Britain)
84%51,446,000
people
Source: The Times August 2009
5%2,993,000people
SCOTLAND8%5,169,000people
WALES
3%1,775,000people
NORTHERNIRELAND
ENGLAND
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
What do we know about how our NHS is performing?
16
Some great news!
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]17
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]18
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]19
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
What do we know about how our NHS is performing?
20
Some less great news!
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]21
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]22
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]23
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSNHS | Presentation to [XXXX Company] | [Type Date]24
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS25
Challenges facing the NHS today
Future pressures
• Improving outcomes against the NHS Outcomes Framework
• Significant inequalities in health and life expectancy
• NHS performance on certain diseases lags behind the rest of Europe
• Burden of long term conditions increasing
• Demands on hospitals, emergency admissions and readmissions rising
• Patient experience is too variable
• Unacceptable safety failures
• Ageing population and rising birth rate
• Increasing burden of disease – e.g. by 2035 46% expected to be obese with 550,000 extra cases of diabetes
• Patient and public expectations rising
• ‘Flat real’ financial settlements expected (i.e. only in line with general price inflation)
• Costs expected to keep increasing with new and more technology
• NHS productivity difficult to increase – grew only 0.4% between 1995 and 2010
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
We could adopt this view…
26
“Be ambitious – you can’t take two steps over a gap”
David Lloyd George
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS30
“What do you mean, you don’t have real authority, you only have influence?”
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The history of the NHS in a triangle…
31
QUALITYSTANDARDS
MONEY ENTITLEMENT
TENSION
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
www.nhschangemodel.nhs.uk
The NHS Change Model
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
What do we need to do?1. Understand the scale of the issue2. Work with patients and be transparent3. Shift public expectations4. Shift from the current clinical model
(Primary/Community/Secondary….Integrated)5. Be relentless on efficiency6. Get the incentives right7. Find, understand and implement best practice8. Encourage innovation
34
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
1. Understand the scale of the issue
35
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The Gap…
36
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The Dependency Ratio is rising alarmingly
38
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
2. Work with patients and be transparent
39
3. Shift public expectations
AND
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
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?
We know there is more to do and recommendations for improvement already exist
Current challenges
What the people we serve want….
Person centred coordinated care
“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”
Communication
Information
Decision-makingCare planningTransitions
My goals/outcomes
Emergencies
8 high impact interventions
45
• 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
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
4. Shift from the current clinical model
46
Why working across organisational boundaries is important
The core area for effective integrated
care
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
5. Be relentless on efficiency
49
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
Improved quality
Cos
t
“Cuts”
“ClinicalDevelopment”
“Drift”
Reduced hospitalisationStandardisationTechnology / innovationTime savingReducing clinical errorWaste reduction
With thanks to Jim Easton
The Magic Box
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
6. Get the incentives right
51
CommissioningCommissioning
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
7. Find, understand and implement best practice
53
8. Encourage innovation
AND
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS
The Academic Health Science Networks
54
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
Aims of NHS EnglandCore objectives for Academic Health Science Networks
@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS56
@helenbevan@HelenBevan @RobertVarnam #IHI25Forum #ChangeAgents
The largest simultaneous improvement initiative in the history of the NHS
@helenbevan
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 RolandStuart Sutton Helen Bevan
Source: @NHSChangeDay
@helenbevan
A 189,000 pledge mountain!
59 Source: @NHSChangeDay
@helenbevan
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 2014www.changeday.nhs.uk
@helenbevan
@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 inspireDov Speidman
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