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January 28, 2018
GETTING THE NHS TO THE MOON IS ABOUT GIANT LEAPS, NOT SMALL STEPS
By: Dan West

Now, I realise that the last thing the NHS needs is to go to the moon, bear with me on the metaphor. It’s become clear that the NHS needs to take some Lunar leaps to transform. Localised, incremental efficiency improvements cannot deliver the changes needed for future sustainability or care. We need to: re-imagine how patient-centric healthcare services are integrated and organised; end perverse, reactive, volume-based care incentives; and reduce the proportion of healthcare services and interactions that rely on high-cost clinicians. We’ll deal with the latter two in a follow-up blog.

Technology will undoubtedly be recruited for the launch of re-imagined, patient-centric healthcare, but the business model must work (if clinicians and administrators are to commit to boarding the lunar lander). A strong candidate for the new business model in our landing party must be Accountable Care Systems (ACSs). I know there’s been much talk of ACSs and privatisation – this blog deals with the benefits they bring, not the organisations that deliver them. Commissioners must moderate the mix of public and private providers. The evidence is compelling: the ACS model has delivered improvements in the US for years. An August 2017 Health Inspector General report reveals that in the first three years of ACOs (Accountable Care Organisations), participating health providers serving 9.7 million members reduced Medicare spending by nearly $1bn, and suggests that more established ACOs are achieving greater cost savings over time. ACOs also improved the quality of care they provided: ACOs improved performance on 82% of the quality measures, and (relevant to the UK), ACOs outperformed fee‐for‐service providers on 81% of the quality measures.

The prevailing NHS view is that population health management drives value-based care and supports risk-based budgeting. I agree, these techniques increase the focus on reducing hospital admissions, length of stay, risk of re-admission, cost of care and bring improvements in quality of life for people with long-term conditions. The regional ecosystem approach that is required to make population health approaches work (STPs and onwards to ACSs) have the ability to eclipse traditional care models, if properly embraced. But the ecosystems must be assisted and equipped to target high-risk groups, integrate more tightly across ‘layers’ of the health and social care eco-system, and redesign financial flows and incentive models to move from a sickness service to a future-proofed wellness service (engaging the population to be healthy and better manage ongoing conditions).

So what?

Our trip to the moon sounds great, but is it a flight of fancy? No… but… transformation needs capital. Capital-starved environments rarely succeed in delivering the transformation needed here. Historically, money is often provided to get to the launch pad, but real investment benefits aren’t realised until you’re in orbit. A virtuous circle of investment would do things now to free up budget for reinvestment in the future. Source external funding, find ways to fund the complete mission. Creating the regional ACSs, and the projects that this will require, is like mounting a moon mission – give me a shout to talk about our experiences so far.

(Note – no astronauts were harmed in the making of this blog).

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