By Corrina Kane
The newly minted NHS Improvement team, led by the impressive Jim Mackey, has a mammoth job on its hands. Not officially launched until April this year, this new NHS regulatory body takes on the majority of Lord Carter’s 15 recommendations, 84 deliverables and 88 pages on ‘Operational productivity and performance in English NHS acute hospitals’. All this in a backdrop of deficits, striking doctors and debates around privatisation. Speaking at the King’s Fund event ‘Moving Towards Place-based Systems of Care’ last week, Mr. Mackey was keen to get across his philosophy of “not getting in the way” of providers undertaking the sustainability and transformation plan. But how does one really drive and deliver change and transformation from the sidelines? Does NHS Improvement have the clearly defined mandate, objectives, resources and stakeholder support required to deliver against such lofty expectations? Not that I can see.
As a tech company focussed on care pathway management, operational productivity is the name of our game. I keenly scoured Lord Carter’s report for innovative and transformational thinking on the role of technology in supporting both system-wide changes, as well as directly impacting the the day-to-day inefficiencies, waste, and bureaucracy that contribute to unwarranted variations, low staff morale, and high costs that are the swan song of the NHS as we know it. Although the bulk of the Carter analysis centres on the billions of pounds of savings to be found in procurement, pharmacy and agency costs, I was heartened to see recognition that “bringing together a system approach to care pathways” features prominently, along with the need to align and collaborate between the various providers, commissioners, associations and clinicians required to build a single version of the truth.
A key enabler of transformation through a system-wide pathway approach must focus on a single reporting framework, and automating a large proportion of that reporting in real time. It is shocking that a highly paid and highly valued Trust Chief Operating Officer could spend 50% of their time dealing with hundreds of slightly different reporting requests from several organisations, the value of which they don’t see for 6 months after the fact. Administration across the whole system has gotten out of hand, with more and more people, paper and process thrown at the cracks in broken pathways. The fact that an average acute Trust has 1 admin staff per 3.7 clinical staff (and the ratio can be as high as 1 to 2.3) means it is unsurprising that Trusts are spending a huge £4.8bn on corporate back office and operational admin costs.
Followers of healthcare IT in the USA will be familiar with ‘Meaningful Use’ as the lever wielded by the US government to force providers into implementing Electronic Health Records (EHR). Through this painful process it has become starkly apparent that forcing providers to adopt technology for technology’s sake was not entirely well thought through. The NHS has a reputation as a laggard, picking up on management fads tried and tested by industry 10 years too late, when the early adopters have already moved on. Now that the first murmurings of meaningful use are surfacing in the NHS, I sincerely hope we can learn from the hard-earned lessons in the US, rather than blindly following them down the same path and through the same mistakes. Perhaps we can skip the mess that is meaningful use, and jump straight to meaningful outcomes.