As the NHS gets serious about shifting attention from illness to wellness, Dr Mark Davies, medical director at MedeAnalytics, details why new plans must focus on individuals rather than organisations.
When Nye Bevan wrote his book describing the setting up of the national health service for the UK he called it ‘In place of fear’. One of the great fears of falling ill pre-1948 was the inevitable bill from the doctor that you would somehow need to pay probably in the context of reduced income due to illness. However, there is now a new fear for the NHS – how we continue to be able to pay for this great institution and make it safe for future generations in the face of spiraling demand and increasing costs. The sustainability of the NHS is what we should be worrying about, but it needs a different way of looking at care.
It is good news that additional money is available to the NHS at a time of increasing austerity for public services. However it comes with the condition that it doesn’t get used for ’more of the same’. The treasury will be well aware of the real risk that additional cash in the NHS will be used to cover deficits, particularly for NHS hospitals which are almost all in the red. It has been made clear that this additional funding will be tied to a different approach to care, one that is both refreshing and long overdue. The NHS has been asked to bid for these funds using the route of Sustainability and Transformations Plans (STPs). These are area-specific whole-system plans that cross multiple organisations and multiple years – they could be described as whole care economy plans. This is less about the running of hospitals and GP surgeries more about how patient care is coordinated and the critical role that prevention has to play.
There are two challenges that make up the Sustainability and Transformation Plans (STPs) – namely to get a financial grip in the short term and lay the foundations of different models of delivering care in the medium and long term. That transformation means, amongst other things, being serious about prevention – this is perhaps the first time that the prevention agenda has been so closely linked to funding, causing some observers to comment that this might be the time the NHS gets serious shifting its attention from illness to wellness. It also calls for health and social care integration as a means of knitting together an individual’s overall experience of care.
This challenge changes the focus of the NHS from being about organisations to being about individuals and populations based in particular areas. This population health based approach creates momentum behind communities coming together, setting aside narrow organisational loyalties in the interest of a system-wide approach to driving efficiency and improved outcomes. If those ambitions are underpinned by contracts that use the structured measurement of outcomes in a pragmatic way, then we can create whole-system incentives to drive effective organisational and individual behaviours.
The first step of such an approach is to understand the interdependencies within a local area, and being able to see individual people within the complex system. This requires a joined up individual level dataset that can be interrogated to gain insights from different perspectives – whether based on a group of patients, disease pathways or service models.
The bringing together of financial data, operational data and clinical outcome data centred around patients gives us an opportunity to understand value and derive the insights that STPs will be based on. This essential first step will reveal the financial pressure points not for an isolated organisation, but for the whole system. In this way a prioritised list of new delivery models can be designed and managed. There is a danger in this however, and one highlighted recently by Jim Mackey is the lazy rush to new organisational forms rather than looking at new pathways of care. It is always easier to look at the anatomy of care rather than the physiology. It is the physiology of care, as in those care pathways that make the real difference to the experience of individual people.
Looking at the whole system and seeing the people, stories and journeys within that system provides a great opportunity for a new way of thinking.
This is perhaps the first time the NHS has been asked to step back and see the wood for trees.