Change to survive — how partnering with suppliers could future-proof the NHS
Thu Sep 21 00:00:00 CEST 2017
When the NHS was founded in 1948, it was to serve a nation exhausted by war and with expectations far lower than those we have today. While the roots of the NHS lay in the knowledge — already decades old by then — that the piecemeal provision of healthcare by councils, charities and others was simply not good enough, it took a war to give Attlee’s Government the impetus to fund healthcare from central taxation. In the early days of the NHS, Bevan himself foresaw that expectations of the NHS would exceed its capacity; now, with society plagued by diseases of civilisation such as heart disease, cancer and obesity, and crisis in health and social care provision, we can see that he was right.
Today people are living longer and with chronic, often multiple, conditions. This, along with advances in medicine, technology and dozens of other, less tangible factors such as the changing nature of the family and communities, lifestyle changes, new expectations of the patient/clinician relationship and even changing ideas about what constitutes health as opposed to illness, have helped to drive the NHS to its current state. And make no mistake about it, the current state of the NHS is critical. It is perhaps facing the biggest crisis in its history.
Not all about the money
To blame all of this squarely on a lack of financial investment is to miss the point. The problems now facing the NHS are systemic and embedded. Nothing short of fundamental change — in resource allocation, in focus, in workflows, in attitudes — is going to be enough to save the UK’s health service.
These are not changes that the NHS can make alone. In a whitepaper, The Transition from Secondary to Primary Care — Moving Closer to Population Health, Siemens Healthineers and several highly-respected healthcare experts, with substantial NHS experience, explain how — by placing the focus firmly on prevention and cutting-edge diagnostic techniques and delivering services via a system that works in genuine partnership with stakeholders, including suppliers — the NHS could be better equipped to meet these challenges.
What must be done?
The good news is that recent political and organisational declarations potentially provide a solid foundation for the type of transformation the NHS requires. Sustainability and transformation plans, and the Next Steps report of March 2017 make it clear that the burden of care must shift from secondary care to primary. That in itself, of course, is nothing new; bringing care ‘closer to home’ has been an NHS mantra throughout the last decade and more. However, there are signs that now, the NHS is looking to embed this change in more wide-ranging, fundamental, cultural and organisational change. That will make all the difference.
The Five Year Forward View seeks to allocate resources by geography rather than by organisation. In doing this it forces everybody in health and social care in a given geographical area to come together to decide how best to use those resources. That takes everybody out of their silos (those great enemies of collaborative working) and gets them talking, discussing, creating solutions. As long as commissioners and providers share common goals and can measure their success, this could generate creative responses, joined-up provision and real change. However, there is still one crucial part of this puzzle missing.
If the NHS can change its relationship with suppliers, it could make a huge contribution to a transformed health service. For suppliers, far from being mere providers of service A in place B under contract C for D period of time (which is how they have tended to be viewed thus far) are actually repositories of knowledge and information that could really make a difference to the NHS. Suppliers know exactly what is possible, how much it costs, likely developments or innovations, what else a product/service can be integrated with and how to do that, and how to manage the entire process to mutual best advantage. Suppliers simply have to know — they would not be in business for long, otherwise.
And why would the commissioners and providers of health and social care services pass up the chance to have such a resource around the table? It would not make good business sense in any context.
The NHS changes proposed are crying out for supplier expertise and involvement at all stages of planning and implementation. Take early diagnostics, for example. Obviously, early and coherent diagnosis leads to better patient outcomes and fewer acute admissions (in particular, un-planned admissions). The current system requires the patient to present themselves at numerous different locations at different times, which is clearly inconvenient and much more likely to lead to missed appointments than a one-place, one-time provision would. The current fragmentation of workflow increases the risk of error and missed opportunities to diagnose and manage optimally.
Suppliers can change this. They can identify the latest diagnostics and interventions, and by working with the wider health and social care community can contribute not only by suggesting their use and providing costs, but also by exploring ways in which their provision might be optimised (for example having all of a given batch of interventions in one appointment, at one location), and thus chances for error or missed opportunity reduced. This is particularly important when the focus is on moving diagnostics and condition management out of acute and into primary care settings. Suppliers can advise on what is best provided in a community setting and how it can be integrated into workflow and other service provision, they can predict upgrades and make early (cost-saving) preparations. Few health and social care providers have that level of expertise in-house — why should they? Now they can get it, almost on tap.
Making the change a reality
The NHS is in the unenviable position of having to move provision from secondary to primary care, but lacks the time, money and expertise to do so in a way that optimises outcomes, and is future-proof. By working in partnership with suppliers at multiple local levels, NHS bodies can change that, and access extremely valuable expertise and information.
Obviously, this is reliant upon all parties aligning their visions and values, establishing measures of success and robust systems of governance, but one of the inherent strengths of the NHS is the freedom to do this at a local level, and in line with local need. In short, the NHS has no choice but to change now, and while that is intimidating, it also offers huge and perhaps never-to-be-repeated opportunity. Let us grasp that opportunity together, and make the NHS fit and ready for a glorious future.