Redesign to save NHS from slash and burn

This unprecedented, unparallelled expectation means that many parts of the NHS face cuts of up to 25 per cent and the choice between slash and burn and radical re-design has come into sharp relief.

So what is to be done? We, the undersigned, from 17 universities, believe there is a new way forward to meet this challenge, which could also achieve a dramatic improvement in outcomes.

The Government’s challenge calls for radical rethinking.  It requires systematic remodelling of processes for every care pathway, at policy, commissioning and operational levels. We appreciate the difficulty of that task - the NHS cannot stop work until we get everything right, central direction would be stifling and patients are not commodities.

However, modelling and simulation offer tremendous benefits. Many tools are already available to help staff operate and deploy resources much more effectively.  Britain has great academic strength in this field to support the clinical leadership required to drive such change. We draw the reader’s attention to the following four success stories already in the public domain:

• East Riding PCT modelled the introduction of the BNP blood test to diagnose heart failure, predict savings and obtain better outcomes.  Subsequent implementation validated the model.  The Lancashire and Cumbria Cardiac Network and the Pathology Commissioning Network, used computer simulation software to generalise this prediction to save more than £100,000 per PCT per year in their areas. Across the country, this change would save over £20-30M per annum and improve outcomes.
• Following the introduction of ‘free choice’, Stockport PCT had to manage a rise in GP referrals to secondary care from, with consequent increases in waiting times.  The team used Scenario Generator to model these pathways and identified how 97% of patients could be seen within 28 days and 100% within 37 days.
• Leicestershire and Rutland Councils, working with NHS partners, used a systems modelling approach as part of the business case development and economic evaluation for an End of Life Care service.  This helped to scale the service and anticipate future potential savings.  The initial assumptions suggested the potential to save c.450 hospital admissions a year, with subsequent evaluation verifying these assumptions and delivering recurrent savings in the order of £1.5M a year from year 3 of the project.
• Examples abound in the US.  The New York Memorial Sloan-Kettering Cancer Center uses an optimisation model to plan radiotherapy treatments, resulting in savings of $millions. On a smaller scale, a primary care clinic in East Carolina used a simulation model to show that overbooking, which is standard practice in the airline industry,  reduced no-shows and produced annual savings of around $300,000.

Further research is needed, not least because, although other sectors have reaped the modelling dividend, the signal successes in the NHS have yet to transform the culture.  However, as healthcare academics rooted in engineering, industry and management where this approach has often been successful, we want to engage with the NHS in a performance step change. We believe that it can deliver a 20:20 vision: 20 per cent more care for 20 per cent less cost.  In terms of outcomes, this equates roughly to an extra 1,000,000 QALYs a year. 

As in other industries, we believe that quality and capacity in healthcare can be transformed through radically remodelled processes and systems and allowing clinical leaders to test the consequences of change before implementation. This will deliver improvements in patient care and the type of extraordinary savings envisaged by the Government.

Yours