Published: 09/05/2002, Volume II2, No. 5804 Page 15
If you're a manager looking for a challenge, or You have got heart problems - or both - you could do a lot worse than pay a visit to Dumfries and Galloway.
Why? Because the area has the first fully functioning managed clinical network for coronary heart disease in the UK.
Which, says the network's lead clinician, Dr Chris Baker, results in huge improvements in patient care - and an approach to service planning that many managers could find 'potentially very threatening'.You have been warned... The NHS in Scotland has pioneered managed clinical networks - a concept central to HSJ's Governance Game in London on 3 October - for the past three years. It describes them as 'linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and health board boundaries to ensure equitable provision of high quality and clinically effective services'.
Introduced after a 1998 Scottish Office review of acute services recommended a shift away from the isolationism of the internal market, pilot networks were set up to help the NHS develop seamless services for particular patient groups, like people with diabetes or coronary heart disease; and in certain specialties, like vascular surgery.
'Traditionally, the NHS has been run by organisations clearly defined by their boundaries, and working to serve their particular populations, ' explains Dr Baker, whose CHD network is now seen as a model for developing others across Scotland and the wider NHS. 'We have turned that on its head by starting off with the patient's needs and going from there.We have got clinicians and patients working together for a clearly defined purpose - to provide the best possible care within available resources, regardless of boundaries.'
From patients' point of view, the advantages of the network approach are clear, says Dr Baker.
His project has introduced evidence-based clinical protocols across all sectors of care, built around patient care pathways.
Innovations include GPadministered emergency thrombolysis; local coronary selfhelp groups; and passport-style, patient-held health records including, for example, copies of discharge electrocardiograms.
In England and Wales, clinical networks are at their most developed in the field of cancer, and the Department of Health says they are here to stay.
In its Shifting the Balance of Power : next steps guidance, the DoH stressed that England's 34 cancer networks, set up in the wake of the 1995 Calman-Hine report on cancer care, must maintain their momentum despite the potential problems of the latest NHS reorganisation.
'Managed cancer networks can develop integrated care, improved clinical outcomes, cost-effective services, improved patient experience and equity of service provision, ' the guidance proudly states.
The managed network approach is already developing in other specialties, including pathology and critical care. But translating the rhetoric of managed clinical networks into reality is not always easy, as the Commission for Health Improvement made clear in its first national service framework assessment of NHS cancer care in England and Wales, published in December 2001.
Highlighting 'considerable' evidence of close co-operation between clinicians working within the cancer networks, CHI said that 'on the managerial front... networks have made less progress... management relationships continue to operate along more traditional lines'.
The commission cited lack of shared history and common views about standards, inadequate involvement from health authority and trust chiefs, and poor communication as typical reasons for the 'slow and uneven' progress of networks.
Dr Baker stresses that managed clinical networks can only work if they focus on 'patients and services, not buildings and organisations', and have clinicians heavily involved in management roles. 'The cardiac services group, which sits at the heart of our network and does all the strategic thinking and resource allocation, is made up of 10 clinicians and lay members, and just two health board members. That means the decision makers have the most up-to-date clinical knowledge around and gain access to patient input at the highest level, ' he says.
NHS Confederation policy director Nigel Edwards believes managed clinical networks have an important place in a modernising NHS.He argues that their 'creativity and fleetness of foot' should be allowed to develop without forcing them to become 'the next structural panacea'.
But he says their success will rely, in part, on the ability to deal with accountability and clinical governance: 'The networks will have to start to think about how they will talk to the public, commission services from other providers, measure their performance, and come to terms with some of the formality of the NHS without losing their spark.'
All this means a brave new world for managers, who must learn to be what Mr Edwards refers to as 'adept leaders, who are familiar and comfortable working with systems operating in an environment of uncertainty and ambiguity, rather than... the more linear, production management model'.
And hence, the HSJ's Governance Game... assuming You have got the heart for it!
The HSJ Governance Game - your chance to play
The HSJ Governance Game is a demanding and exciting simulation game in which teams:
create sustainable networks;
face Commission for Health Improvement-style review;
develop clinical governance arrangements across service networks.
The game has been developed with the Office for Public Management.To find out more, see the advertisement on pages 2-3 or contact Debbie Keogh on 020-7874 0649/ debbie. keogh@emap. com