Review of: 10 Year Plan

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10 Year Plan

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10 Year Plan 2014 Usa [Castellano]

In a professional service organisation like the NHS, improvements in clinical care cannot be mandated by managers and organisational leaders.

Rather, they rely on the actions of frontline teams, and large-scale improvements result from the accumulation of many small changes in care.

Organisational leaders have a role in facilitating these changes by providing the training, resources and time for teams to bring about improvements Ham et al International experience shows how this has been done in high-performing health care systems.

A well-known example is Intermountain Healthcare in the United States which has delivered better outcomes at lower cost by engaging medical leaders and others in identifying variations in clinical care, developing guidelines on how care should be provided, and using peer monitoring and review to improve care.

Work to integrate care can also learn from international experience. The transformation of the Veterans Health Administration VA in the United States in the late s is a powerful case study of a shift from a fragmented hospital-centred system to a series of regionally based integrated service networks that competed with each other to improve care for those they served Ham The priority given to strengthening leadership at all levels of the VA is particularly relevant to the NHS.

The traditional command-and-control, military-style punitive culture was replaced with much greater delegation to network directors who were appointed on the basis of their leadership skills and experience.

A substantial investment was made in clinical leadership and in equipping clinical leaders with the skills and capabilities to bring about change.

The change programme focused on patient safety, quality of care and outcomes rather than on financial performance or efficiency, on the basis that this would resonate more effectively with clinical leaders.

Studies have documented the benefits that were delivered in the VA as a result of its transformation, even though its performance recently has been criticised.

These benefits included reducing the use of hospital beds by more than 50 per cent and improving the quality of care on a number of indicators Ham As in the NHS, expenditure continued to rise in response to growing demand, but over time resources were redirected from hospitals to other services to enable the right care to be provided in the right place at the right time.

Experience of transforming mental health services during the lifetime of the NHS offers other important lessons on how to manage large-scale change.

New forms of care in the community progressively replaced the old asylums, and execution of the new policy was enabled by changing views among staff providing mental health services about the most appropriate way of delivering care.

Mental health services were transformed over many years as a result of shifting social attitudes, innovations in treatments, changes to the law, and strategic leadership by regional health authorities underpinned by additional funding Gilburt et al The clear conclusion is that strategic leadership and additional funding are also essential in making further progress on integrated care and delivering improvements in population health.

Reforming the NHS from within depends critically on building capability among leaders and staff as less reliance is placed on external interventions from regulators and others.

It also means investing in leaders who are able to work across local systems as well as providing excellent leadership in their own organisations.

Action to address leadership vacancies and cultures that deter experienced staff from taking on leadership roles is also needed Anandaciva et al forthcoming.

The ambition to develop integrated care at scale and pace will require changes to the law to remove some of the barriers to progress.

For example, ICSs should be established in law as NHS bodies, changes to the role of regulators will be required to achieve closer alignment with the emphasis being placed on system working and to enable the full merger of NHS England and NHS Improvement, and the law relating to procurement and mergers of NHS organisations will need to be reviewed.

We agree with the Health and Social Care Committee that proposals should be brought forward from within the NHS on what changes are needed and should be scrutinised by parliament.

Ambitions to improve population health will only be realised if there is alignment around these ambitions at all levels and clarity about goals that should be agreed after widespread consultation.

These goals need to be incorporated into a single outcomes framework covering the NHS and local government. ICSs should be held to account for their performance on these outcomes and the results published to enable the public to compare the performance of different systems.

Over time, the outcomes framework would become the main way of managing the performance of ICSs Ham et al More also needs to be done to enable worthwhile innovations and improvements in care to be spread, adopted and adapted throughout England.

Passive diffusion will not achieve this. Evidence shows that peer-to-peer connections are more effective than central edicts and can be enabled through learning networks, improvement collaboratives and communities of practice.

Finally, while there is understandable urgency among politicians and NHS leaders in bringing about improvements in health and care, the clear lesson from previous NHS plans and from international experience is that large-scale, transformational change takes time.

We welcome the commitment to plan for 10 years and to be ambitious about what can be delivered with the funding that has been promised.

Constancy of purpose linked to clarity of aims and skilful implementation, drawing on the commitment of the 1. Acheson D Independent inquiry into inequalities in health [online].

UK website. Available at: www. Alderwick H, Ham C, Buck D a. Population health systems: going beyond integrated care.

Alderwick H, Robertson R, Appleby J, Dunn P, Maguire D b. Better value in the NHS: the role of changes in clinical practice. Anandaciva S, Ward D, Randhawa M, Edge R forthcoming.

Ardern K Annual Health Engagement Conference Wigan Borough Clinical Commissioning Group website. Barr B, Higgerson J, Whitehead M, Duncan WH British Medical Journal , vol , j Baylis A, Buck D, Anderson J, Jabbal J, Ross S The future of HIV services in England: shaping the response to changing needs.

Black D, Morris J, Smith C, Townsend P Inequalities in health: report of a research working group. London: Department of Health and Social Security, Bottery S, Varrow M, Thorlby R, Wellings D A fork in the road: next steps for social care funding reform.

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Evans H Evans H, Buck D Tackling multiple unhealthy risk factors: emerging lessons from practice. Galea A, Naylor C, Buck D, Weaks L Volunteering in acute trusts in England: understanding the scale and impact.

Gilburt G, Buck D, South J Volunteering in general practice: opportunities and insights. Gilburt H, Gregory S, Baylis A Modelling excellence in the charity sector: learning from 20 years of the GSK IMPACT Awards.

Gilburt H, Peck E, Ashton B, Edwards N, Naylor C Service transformation: lessons from mental health. Hall D Local Government Chronicle. Ham C Reforming the NHS from within: beyond hierarchy, inspection and markets.

Ham C, Berwick D, Dixon J Improving quality in the English NHS: A strategy for action. Ham C, Edwards E, Dixon J Ham C, Raleigh V, Foot C, Robertson R.

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Johnson P, Kelly E, Lee T, Stoye G, Zaranko B, Charlesworth A, Firth Z, Gershlick B, Watt T PHOTO: MTI. Charmaine Ng.

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10 Year Plan


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