21 Oct 2015
The NHS has been asked to make efficiency savings of £22bn within the next five years – a fearsome prospect for those working within a complex healthcare system already splitting at the seams.
Yesterday, London Business School's Deloitte Institute of Innovation and Entrepreneurship hosted speakers from the NHS and healthcare providers from across the world, to address Driving Innovation in Healthcare Delivery.
The discussions for leaders of change in healthcare were led by Kamalini Ramdas, Deloitte Chair of Innovation and Entrepreneurship, London Business School, who was joined by Chairman of NHS England, Sir Malcolm Grant and international speakers from world-leading healthcare providers.
Professor Ramdas, like many experts, believes the road forward starts with radical innovation.
“Our ability to deliver the standard of healthcare which is free at the point of delivery and which has made the UK the envy of the world will stand or fall by our ability to innovate radically,” she says.
And the UK is not alone. Worldwide, talented doctors and management teams are doing their level best to deliver world-class healthcare to a record volume of people. Pressure on healthcare systems is forcing the adoption of innovation.
There is no shortage globally of inspiring examples of healthcare done differently.
“Radical innovation is not a leap of faith if you know how to experiment quickly and cheaply”, says Professor Ramdas.
Dr Rengaraj Venkatesh, Chief Medical Officer, Aravind Eye Hospital, Pondicherry (India) and Mr Thulasiraj Ravilla, Executive Director – LAICO, Aravind Eye Care System, are now world leaders in experimenting with shared appointments. Professor Ramdas worked with them in the early days as they developed pilots. They are now starting to see gains in their experiments with this concept.
“Many patients feel anxious and intimidated in consultations and often they want more information about the progression of their disease than a doctor can impart economically”, she explains.
“In shared appointments the information one patient gets can spark questions from others, the answers to which may be relevant for everyone, including the doctor. Patients can see a doctor more frequently by dropping into shared appointments and they provide a natural support group for patients who find the one-to-one interactions intimidating.”
At the Cleveland Clinic, a major US hospital system and also a leader in the use of shared appointments, patient waiting lists in some areas were reduced by almost a third with the introduction of shared appointments. Crucially there was also an increase in patient satisfaction.
“The power of the group enables patients to share information about prescriptions, tests, progress and challenges. Research has also found that patients who attend shared appointments are more motivated precisely because their interaction with the healthcare provider has been redesigned to include fellow patients”, Professor Ramdas explains.
With shared appointments, there’s no new science, no difference in preventative cures. It is a redesign of conventional interactions to increase patient satisfaction and improve clinical outcomes.
“It is proof that innovation can positively improve patient care and at the same time cut costs”, Professor Ramdas says.
Experts agree that the biggest barrier to innovation is not a shortage of ideas, but the right environment for adoption.
Michael Standing is Senior Partner at Deloitte’s Global Lifescience & Healthcare practice. He told the conference that: “Innovation isn't really the issue. The issue is adoption. You have pools of expertise that occasionally interface. What we need to address is how we become more cooperative."
Speaking for NHS England, Sir Malcolm Grant said:
“Our real concentration now is on removing silos between primary and secondary care with one big lesson from history... we need to break away from top down [approach] and the instability [of changing ideas].”
He talked about a system versus individual providers and the most dangerous moment for patients being when care is transferred from one provider to another.
There are also challenges with the structure of finance, as Adrian Bull, Managing Director, Imperial College Health Partners explained: "One of the problems for the NHS is the ability to offset the cost of innovation against the benefits," he said, giving the example that innovation could be in primary care, with the cost reductions benefitting secondary care.
"At the moment the NHS is a dysfunctional market for innovation", he said.
He believes academics and leaders of change face the challenge of pushing ideas into a system not yet set up to receive them.
The Deloitte Accelerated Access Review, which aims to enable funding models to work as a whole by recording both the costs and benefits, is one of a number of tools trying to address the challenges of adoption. In NHS England, Sir Malcolm Grant explained that: “Two models have emerged: multi-professional centres of care and hospitals employing GPs so you could have a single pathway of care. These are two of 50 NHS England vanguards transforming care."
The Driving Innovation in Healthcare Delivery event came at a time of deep concerns in the medical community.
On Saturday, thousands marched in London - as well as in Belfast and Nottingham - in protest against proposed changes to junior doctors’ contracts, which would include removing a clause enabling them not to have to work on a Saturday or Sunday, leading to fears from some that more talented doctors will apply to work overseas.
But, as Professor Ramdas explains, the numbers row may be a red herring: “Until now, the debate has largely centred on the numbers. The number of consultants, the number of junior doctors, the number of doctors who feel disillusioned, over-worked and underpaid and the increasing number applying to the General Medical Council (GMC) for Certificates of Current Professional Status (CCPS) to work overseas.
“The numbers are not unimportant, but a singular obsession with numbers may leave us blinkered and missing potential solutions to critical pressure points in a healthcare system which, for all its complexity and challenges, is still free at the point of delivery and the envy of the world.”
“Most physicians I ask spend more than half their time on tasks that don’t require medical expertise,” said Professor Ramdas.
“Consultants in outpatient clinics for example, are often tasked with entering their patients’ results into a computer database during the patient consultation. This is a task that other personnel may actually perform better. Despite spending years in medical school, physicians are rarely trained in data entry.
“Reassigning this task to a member of clerical staff would allow for a more person-centred and a shorter consultation. The consultant could use some of the time saved to engage in more personal interaction and even then see more patients in any shift, working through the waiting list at a quicker rate.”
Earlier this month, the NHS Alliance and Primary Care Foundation published the report, ‘Making Time in General Practice’. Analysing a study group, it summarised that as many as 1 in 6 patients could have been seen by somebody other than a GP in the wider primary care scheme – clinical pharmacists, practice nurses or physician assistants – or received support to help themselves with their health problems, sometimes known as social prescribing.
Dr Toby Cosgrove, Chief Executive Officer, Cleveland Clinic (USA), said: "What really concerns me is how we fail to use the skills of highly skilled professionals who are not doctors. Experimenting with new models of manpower in healthcare – the new era is now upon us."
“Clearly you need the right investment in appropriate support staff, but the evidence shows there are huge gains to be had from re-allocating service tasks. Both efficiency and professional satisfaction improve when time and effort are better aligned with professional identities, expertise and aspirations”, Professor Ramdas says.
With such huge gains in sight, experts agreed with their host: the time to innovate is now.