NHS reform at pace and scale
Next year, the NHS will be 70. But the need for change and reform in the present day is every bit as urgent as ever.
My mission since becoming Health Secretary has been to change the fabric of the NHS to make it more open and transparent, and ultimately to help staff deliver the safest, highest-quality healthcare in the world.
This is about addressing the shocking conclusions of Robert Francis’s Inquiry into Mid-Staffs, and is ingrained in the clinical imperative ‘first, do no harm’. But it’s also – in my view – the only route to long-term stability for the NHS.
Why do I say this?
Well, I look first at international studies, which show that 3.6 per cent of all deaths are avoidable in advanced nations, and that the equivalent of one in every five pounds spent is not used effectively in healthcare settings.
We have to assume the NHS is no different – indeed this is a point reinforced by Lord Carter’s world-leading work on efficiency. We also know that variation in clinical practice is one of the big areas where we can make progress and save money.
In the acute sector, bed sores in hospital cost £2,500 on average per patient; someone falling in hospital adds a further £1,200 per case. All of these are avoidable errors, and so avoidable costs.
In primary care, we find a several-hundred-fold variation in the rate GPs refer patients for some diagnostics tests, and rates of elective tonsillectomies range from about 150 to around 400 per 100,000 young people. That cannot be right.
Furthermore, we know what good looks like. The Sepsis Six bundle, for instance, is bringing consistency and focus to how sepsis cases are identified and treated, showing that safer practices, when applied systematically, can transform outcomes and associated costs.
The challenge therefore is to establish best practice at a new scale.
That’s why we’re opening the new Healthcare Safety Investigation Branch from April. Modelled on the airline industry’s pioneering approach to safety monitoring, it will help us capture and apply the lessons from mistakes made within the NHS in a more systematic way.
And it’s also why I want hospital trusts to publish their avoidable-death figures later in the year – this will mark another step change in openness, encouraging the transparent and critical exchange of insights and analysis that is the hallmark of every industry that “does” safety well.
Most importantly of all though, this shared reform mission is why the NHS’s best years lie ahead.
This article was first published in Reform’s ‘NHS reform at pace and scale’ conference brochure.