How can we innovate and reshape care pathways to better address the UK’s healthcare challenges?

A report back on the viewpoints from Senior UK Heath and Care Leaders

 at a recent breakfast meeting in London

The summary themes from the views are:

Provision of health and social care in the UK is at an inflexion point, with internal and external reports of the NHS referencing it as ‘breaking’ and general election debates highlighting the central importance of the topic to the British electorate.  The hosts convened a group of 14 senior leaders to examine current bright spots of successful innovation in the system and discuss what is needed to deploy and diffuse these and other innovations at scale alongside the ability for at-scale innovation-led transformation within a medium timeframe.

The following themes emerged in this engaging and passionate discussion:

• There are plenty of  examples of innovation in the UK system – including  those based on technology (such as robotic assisted surgery) and organisation (through some Integrated Care Systems and other local approaches)
• Adoption and scaling of innovation is the real issue – the NHS healthcare system is not naturally set up for rapid adoption of innovation, and there is seldom a compelling drive leading adoption where it is needed.
• Health & Care Innovation encompasses more than clinical innovation – it can be broken down into  5 areas.  The NHS may  have over focussed on clinical innovation and focussed less on organisation and management innovation.
• Successful innovation requires two levels of system change:
  • A. Influencing and shaping conditions for systemic innovation centrally
  • B. Adoption of local innovations across a network of health and care geographic footprints (typically Integrated Care Systems).

The breakfast meeting was hosted by

Alastair Mitchell-Baker (Director Tricordant Organisation Consultants), Paul Lambert (Founding Director, Living Work Consulting), Simon Betty (MD EMEA, Northwest Healthcare Properties ) and John Deverill (SRO South East London Diagnostic and Treatment Centre).

Opening Viewpoints from: Dr Axel Heitmüller (MD, Imperial Health Partners) and Nigel Edwards (Health Policy Advisor, WHO, Kings Fund and former CEO Nuffield Trust)

Attendees:

Grant Bourhill (Managing Director, Barts Life Sciences), James Murray  (Chief Customer and Strategy Officer, Nuffield), Mark Chapman (CEO Alliance Medical GmBH), Rob Anderson (Global CEO, Everlight Radiology), Simon McGuire (GE Healthcare Zone President – EMEA2), Ursula Montgomery (Bayer UK), John Taylor (Director, Tricordant)

Following the opening viewpoints the group discussed and debated a number of points of view, out of which the following emerged as the main topics to take forward.

There are bright spots of innovation in the UK system.

There was an initially downbeat conversation as participants reflected on the significant challenges facing the provision of public health. Life expectancy is no longer rising, and health inequalities are widening.  Whilst life expectancy has increased for many years, it is often now combined with major health conditions.

Demands on the NHS and social care are increasing, within the context of perceived chronic under-investment. [ This is exacerbated by staff shortages, with stress and burnout at high levels. With a core service that is underfunded, there was a recognition that it is hard to find the financial headroom required to innovate , and operational and financial pressure on leaders is such that there is insufficient headspace to allow consideration of innovative ideas.

Despite this context there are reasons to expect that innovation can flourish – given the right environment.   Some examples were discussed:

• Separate innovation funds (Some NHS examples in London) to fund experimentation, even where relatively small.
• Technology development including robot assisted surgery, and further development of the NHS App.
• Integrated Care Systems beginning to provide whole area solutions to issues such as frailty, childhood development and elderly care.
• Futures Boards in some ICSs – deliberately looking from 3 years out and how new practice could be integrated into the regional system
• Development of large scale elective surgical centres (an organisational innovation, often building on learning from private sector).
• Primary care – where many practices have adopted next generation access models and can offer same day appointments to all their patients who need them and yet, many practices struggle with not fit for purpose systems

Scaling and diffusion of innovation is the real issue.

Both the private and public sector leaders recognised individual bright spots of innovation.  Their shared view of the  overriding issue was the lack of  successful up-take, with the health and social care system unable to pull improved and innovation practice into and across the system.  There is substantial resistance to change in the current system.

The root causes of this resistance were identified as:

• In a financially constrained environment, available money goes into fixing the basics.
• Top down imperatives of delivering short-term operational and financial performance focus leaders on the here and now, and not long term effectiveness and outcomes.
• There is no dedicated budget – innovation can’t work its way through the full innovation funnel to scale.
• Typically when innovative approaches are agreed with private sector providers, they are left holding all the risk, which can be hard to justify to their Boards or shareholders.
• Short term budgeting and governance – there were examples given of equipment and supplies being paid for but not delivered because of bureaucratic procurement processes and short term budgeting.
• The whole system is simply too large to make the jump from local pilot to system adoption – deployment at manageable scale is an essential first step..  The group saw Integrated Care Systems as an important step towards this scale.
• Most measures of systems effectiveness are input measures, such as the number of appointments, rather than health and social care outcomes. Outcome measures offer more potential.

We have over focussed on clinical innovation and under focussed on organisation and management innovation.

The group reflected on the excitement around clinical and technological innovations, such as new vaccines and AI processing of scans, and the benefits derived from these.  When considering the value and scale of benefits that can be derived from adopting existing innovations (e.g. integration of social and healthcare across an elderly care pathway), it was clear that we should be shifting our emphasis to organisational and management innovation. There are examples across emerging ICSs of provider collaboratives, CDCs and integrated neighbourhood teams, which show the value of organisational innovation.  The table below reflects the 5 areas of innovation and examples from healthcare.

Enabling successful innovation will require two levels of system change:

• Influencing and shaping conditions for systemic innovation centrally
• Diffusion of local innovations across a network of health and care geographic footprints (typically Integrated Care Systems).

There were many excellent examples of local innovation shared across the group. However, earlier reflections on the blockers to scaling and diffusing innovation led the group to conclude that the benefits will only be felt if there are central enablers and local innovations.

This would include the centre doing what it is best at, such as:

1. Defining overall standards – such as common formats and policies for population health and social care data.
2. Longer term funding – allocating funding over multi-year periods to enable planning and investment (in same way the rail sector looks at 5 year control periods)
3. Providing sharing forums of good practice e.g. ICSs sharing good practice case studies
4. Better measurement – looking at outcome rather than input measures nationally.

And improved local / regional working arrangements:

1. Ensuring that Integrated Care Systems can, and do, act as local system convenors and more  than glorified bank accounts (as one participant put it).  Examples such a clear strategic and holistic focus on health inequalities in linking employment opportunities to local Community Diagnostic Centre  development, or  a ‘Futures Board’ for an ICS drawing input from a diverse range of informed stakeholders were held up as good examples of how this can be encouraged.
2. Separating funding for innovation and improvement from core service funding.
3. Creating more public and private partnership locally with risk shared across supplier and healthcare district.

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