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Redesign to save NHS from slash and burn

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Originally published in the Health Services Journal 17 December 2010

Dear Sir,

In a blunt assessment of the coming few years, the Commons Health Select Committee recently stated that the NHS must achieve efficiency savings on a scale never before seen here, or indeed in other countries.

This unprecedented, unparallelled expectation means that many parts of the NHS face cuts of up to 25 per cent and the choice between slash and burn and radical re-design has come into sharp relief.

So what is to be done? We, the undersigned, from 17 universities, believe there is a new way forward to meet this challenge, which could also achieve a dramatic improvement in outcomes.

The Government’s challenge calls for radical rethinking.  It requires systematic remodelling of processes for every care pathway, at policy, commissioning and operational levels. We appreciate the difficulty of that task - the NHS cannot stop work until we get everything right, central direction would be stifling and patients are not commodities.

However, modelling and simulation offer tremendous benefits. Many tools are already available to help staff operate and deploy resources much more effectively.  Britain has great academic strength in this field to support the clinical leadership required to drive such change. We draw the reader’s attention to the following four success stories already in the public domain:

  • East Riding PCT modelled the introduction of the BNP blood test to diagnose heart failure, predict savings and obtain better outcomes.  Subsequent implementation validated the model.  The Lancashire and Cumbria Cardiac Network and the Pathology Commissioning Network, used computer simulation software to generalise this prediction to save more than £100,000 per PCT per year in their areas. Across the country, this change would save over £20-30M per annum and improve outcomes.
  • Following the introduction of ‘free choice’, Stockport PCT had to manage a rise in GP referrals to secondary care from, with consequent increases in waiting times.  The team used Scenario Generator to model these pathways and identified how 97% of patients could be seen within 28 days and 100% within 37 days.
  • Leicestershire and Rutland Councils, working with NHS partners, used a systems modelling approach as part of the business case development and economic evaluation for an End of Life Care service.  This helped to scale the service and anticipate future potential savings.  The initial assumptions suggested the potential to save c.450 hospital admissions a year, with subsequent evaluation verifying these assumptions and delivering recurrent savings in the order of £1.5M a year from year 3 of the project.
  • Examples abound in the US.  The New York Memorial Sloan-Kettering Cancer Center uses an optimisation model to plan radiotherapy treatments, resulting in savings of $millions. On a smaller scale, a primary care clinic in East Carolina used a simulation model to show that overbooking, which is standard practice in the airline industry,  reduced no-shows and produced annual savings of around $300,000.

Further research is needed, not least because, although other sectors have reaped the modelling dividend, the signal successes in the NHS have yet to transform the culture.  However, as healthcare academics rooted in engineering, industry and management where this approach has often been successful, we want to engage with the NHS in a performance step change. We believe that it can deliver a 20:20 vision: 20 per cent more care for 20 per cent less cost.  In terms of outcomes, this equates roughly to an extra 1,000,000 QALYs a year. 

As in other industries, we believe that quality and capacity in healthcare can be transformed through radically remodelled processes and systems and allowing clinical leaders to test the consequences of change before implementation. This will deliver improvements in patient care and the type of extraordinary savings envisaged by the Government.

Yours

Dr.

Mike

Allen

Associate Professor Clinical Systems Improvement

University of Warwick

Professor

James

Barlow

Chair in Technology and Innovation Management

Imperial College London

Dr.

Steffen

Bayer

Research Fellow

Imperial College London

Professor

Ann

Blandford

Professor of Human–Computer Interaction

University College London

Professor

Sally

Brailsford

Professor of Management Science

University of Southampton

Professor

Thierry

Chaussalet

Professor of Healthcare Modelling

University of Westminster

Professor

John

Clarkson

Professor of Engineering Design

The University of Cambridge

Professor

Con

Connell

Director, Centre for Narrative Studies

University of Southampton

Professor

Brian

Dangerfield

Professor of Systems Modelling

University of Salford

Dr.

Tillal

Eldabi

Senior Lecturer

Brunel University

Professor

Paul

Harper

Chair in Operational Research

Cardiff University

Mr

Aylmer

Johnson

Senior Lecturer

Dept .of Engineering, Cambridge University

Professor

Mike

Kagioglou

Chair in Process Management

University of Salford

Dr.

Jonathan

Klein

Senior Lecturer

University of Southampton

Professor

Khairy

Kobbacy

Professor of Management Science

University of Salford

Professor

George

Lewith

Professor of Health Research

University of Southampton

Professor

Richard

Lilford

Professor of Clinical Epidemiology

University of Birmingham

Dr.

Adele

Marshall

Director of Research

Queen’s University, Belfast

Professor

Sally

McClean

Professor of Mathematics

University of Ulster

Professor

Ray

Paul

Professor of Simulation Modelling

Brunel Universty

Dr.

David

Paynton

GP

 

Professor

Mike

Pidd

Professor of Management Science

Lancaster University

Dr.

Martin

Pitt

Senior Research Fellow - Healthcare Modelling

Peninsula College of Medicine and Dentistry

Dr.

John

Powell

Associate Clinical Professor in Epidemiology

University of Warwick

Professor

Andrew

Price

Professor of Project Management

Loughborough University

Dr.

Lampros

Stergioulas

Reader

Brunel University

Dr.

Simon

Taylor

Reader

Brunel University

Dr.

Christos

Vasilakis

Principal Research Fellow

University College London

Professor

Terry

Young

Chair of Healthcare Systems

Brunel University

 

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