Thursday, 29 October 2009

Innovating out of Recession in the UK NHS

There is a lot of interest in public sector innovation, both here in UK, but also in the USA and in other major economies. The recession is forcing a hard look at funding, productivity and quality in service delivery - while maintaining clinical excellence. Last night, I attended a series of lectures at the London School of Economics (LSE) - entitled "Innovating out of the Recession in the NHS". The speakers were Jim Easton, NHS National Director for Improvement and Efficiency, Dept of Health; Steve Barnett, Chief Executive, NHS Confederation and Prof. Patrick Dunleavy, LSE Public Policy Group. Mr. Easton is responsible for driving measureable improvements in service quality and productivity through the system. The meeting was chaired by Howard Glennerster, Prof. Emeritus of social administration at the LSE, holding various advisory positions to UK Government.

I developed this Southbeach model (below) based on remarks which recurred throughout the sessions. I will be developing more models of the positions taken at the meeting. This model says:

The economic downturn has led to a £20B gap in funding. This reality, and the politics around it, will challenge NHS social principles unless there is a step change in productivity and quality. According to Jim Easton, incremental improvements will not achieve this, a transformation of the healthcare 'industry' is required (action). Only this can counteract the funding crisis and avoid much cherished principles being compromized. According to the speakers, a root cause is the NHS culture/ethos, which is harmful to the dissemination of innovations in service delivery, even if it does deliver clinical excellence and patient care. A major theory/reason stated for this is the harmful tension between national programs and local programs. This tension counteracts each of their contributions to the the dissemination of innovations, which are required, but insuffient (dotted line), for the productivity needed (scale up). At the same time, productivty can (questionably) lead to improved clinical practice, yet there is a sense in which silo clinical practice is counteracting productivity. There are unanswered questions here. Of course, if NHS principles are challenged the 'system' cannot counter the funding crisis with an appropriate step change in innovation, there will be a counteracting impact on the culture/ethos. In the model, this has been determined to be useful (green line) because the impact is directed to a harmful element (red box), the culture ... despite this having many useful qualities such as clinical excellence (green box). This illustrates the power of Southbeach to allow for the modeling and resolution of differing 'perspectives'.

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