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England 'could learn integration lessons from Wales'

The NHS in England could learn lessons from Wales when it comes to getting different parts of the health service to work together, the chief executive of NHS Wales has said.

Launching his first annual report as chief executive, David Sissling said improved results for patients with long-term conditions showed efforts to integrate care in Wales, stemming from a major reorganisation in 2009, were starting to bear fruit.

The report shows significant reductions in emergency admissions and emergency readmissions for coronary heart disease, chronic obstructive pulmonary disease and diabetes.

Performance in Wales

Emergency admissions for diabetes went down 14.6 per cent from 2,209 in 2010-11 to 1,886 in 2011-12 while the number of emergency readmissions went down 29.6 per cent

Emergency admission for coronary heart disease went down 9.3 per cent; emergency readmissions went down 19.4 per cent

Emergency admissions for COPD went down 16.5 per cent from 6,835 in 2010-11 to 5,708 in 2011-12, with a 24.6 per cent reduction in emergency readmissions

“Some of the work we’re doing on integration is very important,” Mr Sissling told HSJ. “We’re bringing together single health systems – primary, community, secondary care - and developing models which bring greater continuity. The evidence of that working is some of these shifts in care.”

The 2009 reorganisation saw the creation of seven large-scale local health boards responsible for planning, securing and delivering all healthcare services within their areas.

The structure also includes three pan-Wales trusts – an ambulance trust, one delivering specialist cancer and other national support services, and the new Public Health Wales.

Mr Sissling, who has held senior NHS management roles in England, said the report showed the new arrangements in Wales were “beginning to deliver improvements”, especially when it came to integrated care.

“We’re seeing care which previously required hospital attendance and admission being provided either in community care settings or at home,” he said.

However, he said the new structure required “different” management skills which was why NHS Wales was developing a leadership programme for boards.

“Leadership in health systems is quite different to working at a single organisation and leadership for a hospital or range of community services,” he said.

“Many of our organisations have budgets of over a billion pounds and employ some 16,000 to 17,000 people.

“There needs to be an ability to understand – through good data and intelligence – the way the system is working and not individual parts.”

NHS Wales could learn from some of the work to develop trust boards in England, he added.

Another area where NHS Wales was leading the way was clinical engagement, claimed Mr Sissling, with a goal of getting 25 per cent of all clinicians actively involved in improving services.

He said Wales’s 1,000 Lives quality improvement campaign had “really galvanised clinical interest because it plays to matters of quality, safety and outcomes and is based on identification and adoption of good clinical practice”.

Overall Mr Sissling said NHS Wales had made “real progress in many areas” over the past 12 months but admitted finance “will continue to be a problem”. It has been widely reported that the budget faces a significant real terms cut in 2013-14.

“We’re having to accommodate the pressures of inflation, demand and new technology within the same cash situation,” he said.

Other challenges included achieving further reductions in unscheduled care, reducing health inequalities and implementing further plans to redesign services.

Key developments include the publication of a draft compact setting out a commitment to involving patients and the wider public – due out imminently - and the publication of health outcomes data for each local health board starting with stroke care data later this year.

Mr Sissling said NHS Wales was keen to learn from good practice in all four UK nations and was particularly interested in “the way the financial regime in England has developed”.

“Not the tariff itself but the ability to analyse and understand the way that money is spent within the context of clinical service delivery,” he said.

“We are planning to move to a similar system so we can understand the way resources are deployed.”

Readers' comments (5)

  • Integrated care involving Acute, Community, Mental Health, Ambulance Services and Primary Care in a single NHS Trust has been working for the past six years on the Isle of Wight, only for the latest re-organisation in England to break it up again!!
    We will never learn - well done to Wales Healthcare - it is the only way forward.

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  • ...and finally some coverage for NHS Wales in HSJ !! Love your news, but you do tend to forget us you know !

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  • Good point Paul. Would the HSJ consider running regular columns to tell us what's happening in the devolved nations under the "local" news, rather than English organisations only? All I know is that they haven't split their health service into "bits" and they don't use the tariff, and there are lots of reports comparing outcomes which all seem to come to different conclusions because the data's so different. But I would love to learn more about how they do things!

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  • It seems like Wales and Scotland have a sensible and non-doctrinal (right wing ideology) approach to delivering healthcare!

    Markets and privatisation have no role to play in delivery of healthcare, wish I could move to Wales!

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  • Don't get carried away! Wales has its problems, and we have not got it completely right yet!

    What will be useful is HSJ to continue to have an interest in service progression & value for money within NHS Wales. Integration is the way forward, lets learn together.

    After all we should be able to laern & share from all 4 countries not just concentrate on English NHS

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