The opening ceremony of the Olympics was a proud moment for the NHS.
The showcasing of the service to a worldwide audience of over one billion emphasised the place of the NHS in the British psyche. If we are looking for confirmation that the NHS is, in Nigel Lawson’s words, “The closest thing the English have to a religion”, this was it.
There could now be a tendency to become self-congratulatory about the NHS, and its ability to carry on as normal, but instead the NHS should take this opportunity to learn from the Olympics what real performance improvement means. If you are a challenger, you want to reduce the gap in performance. If you are the record holder, you want to strive to do anything within the bounds of legality to improve your performance.
As Dave Brailsford of Team GB Cycling calls it, this is the “aggregation of marginal gains”. For the NHS, it is about reducing variation between the best and worst - raising the standard to the best.
Take treatment for heart attack. There is a 34-fold variation across primary care trust areas in the rate that patients suffering myocardial infarction receive primary angioplasty - a delay in delivering the recommended treatment leads to poorer outcomes. There is a 12-fold variation in screening for diabetic retinopathy - early diagnosis and treatment of eye problems in diabetes prevents up to 98 per cent of severe vision loss. For type 2 diabetes there is a ten-fold variation in patients receiving the “gold standard” nine key care processes.
The NHS has had a decade-long focus on improvement, supported first by the Modernisation Agency, then the NHS Institute and now the quality, innovation, productivity and prevention agenda, based on the premise of £20bn worth of improvement in the way things are done differently.
Yet significant variations still exist and in some cases appear inexcusable. Drawing on the example of the phenomenally successful Team GB, a number of things can be done.
First, prioritise. What is the NHS equivalent of “sitting down” sports? Choose areas where there will be real impact and make them a national priority. Maybe focus on patients with long-term conditions who use the greatest number of inpatient days? Or tackle mental illness?
Second, fund. Team GB has benefited hugely from lottery funding. There is no equivalent for the NHS, so it will be necessary to prioritise spending. This will be the tricky role for clinical commissioning groups, but they should be given guidance to ensure that what is of national importance is funded, or not funded, locally.
Third, standardise. The rigid standardisation in Team GB cycling has enabled individuals to maximise their performance. There is plenty of evidence in the main clinical areas for what works and does not, so let’s end this charade of “clinical freedom” where plainly there is a standard way of doing things.
Fourth, teamwork. Some sports are obviously based on teamwork, like basketball or road racing. Even in individual sports it’s the team behind the scenes that underpins success. The latitude for solo players in the NHS is fast diminishing, and wider teamwork with local authorities is essential.
Finally, long term. Athletes are turning their attention to the Commonwealth Games in 2014 and Rio in 2016. For the NHS to change the demand curve and utilise its resources, significant change will be needed for it to become a wellness service.
The opening ceremony aligned the NHS with the Olympics. Taking a similar approach to performance as Olympians will ensure a true legacy for London 2012.
John Deffenbaugh is a director of Frontline