On The NHS' 60th Birthday, The Darzi Review Should Drive Innovation Through The Health Service, UK

Main Category: Public Health
Article Date: 28 Jun 2008 - 1:00 PST

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In their latest report, leading think tank Policy Exchange show how a radical approach to innovation in the NHS would save over a billion pounds and thousands of lives. All change please, written by Professor James Barlow (Imperial College) and Jamie Burn, illustrates six specific case studies which show how costs and lives could be saved.

The cost of healthcare is being driven up through changes in demand, demographics, production and labour costs, and new diagnostic and treatment opportunities. These demands mean that the NHS must be as efficient as possible in adopting the best existing practices, and the most beneficial technological and process innovations. Yet the NHS' performance in taking up and spreading innovations and existing best practice is poor.

The rate of uptake of new drugs in the NHS is among the worst in Western Europe. In 2001 it was at best half that in Germany and a third of that in France, and this trend has not abated. But it's not just a question of slow uptake of new technologies. There are also serious problems in getting new and existing practices to spread, even when they are demonstrably beneficial.

There is an aversion to taking risks, because the blame for failure outweighs the reward for success and there is also a chronic lack of long-term strategic thinking, not least because policy shifts are commonplace - there have been five Health Secretaries in the last ten years, each with some wonderful new solution to the problems of the NHS. Other challenges include the fragmentation between healthcare organisations, professional and cultural silos and the funding system.

Policy Exchange's report, written by Professor James Barlow (Imperial College) and Jamie Burn illustrates six specific case studies which show how costs and lives could be saved.

The main recommendations are based on input from almost forty leading policy-makers. These include:

-- Linking the current payment system to an innovation agenda, through the introduction of a new tariff based on best practice, incorporating bonus payments for high quality interventions;

-- Creating a one-stop shop for gathering and disseminating evidence for innovations. In the future, the guidance producing bodies could be merged into a single authoritative source in order to simplify the system;

-- Developing metrics for the measurement of clinical outcomes and systematically collecting patient reported outcome data, in order to produce public tables benchmarking the quality of performance;

-- Using the commissioning process to actively improve the uptake of innovations and best practices, and to foster cooperation between providers in regional health economies.

Gavin Lockhart, Head of Health and Social Care research, said:

"Tackling existing cultures in the NHS is fundamental in building an innovative environment. As our interviews have revealed, the message to leaders in local Hospital Trusts is often restrictive - as one interviewee put it: 'don't rock the boat, don't change anything, just leave things alone, run your own business well and don't get too excited.'

"But it doesn't have to be like this. As our forthcoming report shows, stakeholders in the healthcare system could be incentivised to change behaviour, adopt innovations or use recognised best practice, but currently the tools for doing this are blunt. There is a lack of incentives to improve quality because the current system pays for activity rather than results and, as such, does not reward improvements in the standard of care that patients receive.

"Lord Darzi's much-anticipated review of the NHS offers an opportunity to rethink the approach to innovation in healthcare. With careful reform the Government would be able to tackle the barriers to the uptake and spread of innovation, and most important of all, make sure that acknowledged best practice spreads. The overall beneficiaries of such a reform would undoubtedly be the most important stakeholders in the NHS: the patients."

The Pace of Innovation in the NHS

The uptake of new technologies associated with heart failure showed the UK to be both 'slow' and 'late' â€" we fit 430 new pacemakers per million of the population, compared with 900 per million in France, Germany, Belgium and Spain, despite cardiac arrhythmias being among the top 10 causes of unplanned hospital admissions.[i]

Over 40,000 patients in Germany use insulin pumps to manage their diabetes compared with less than 2,000 in the UK.[ii] Out of 19 European countries, the UK was consistently below average in the adoption of new drugs for the treatment of breast cancer, colorectal cancer, lung cancer, and non Hodgkin's lymphoma.

The 2007 Comprehensive Spending Review (CSR) linked variations in NHS productivity to variable practice and technology uptake. It stated that "reducing such unnecessary variation could potentially generate net cash savings of £1.5 billion per year by 2010-11".[iii]

www.policyexchange.org.uk

[i] McClellan, M. and Kessler, D for the TECH Investigators (1999) A Global Analysis Of Technological Change In Health Care: The Case Of Heart Attacks, Health Affairs, 18(3): 250-255.

[ii] Fitzpatrick, A, 'The Cutting Edge', Medical Technology and Innovation, MTG, Issue 14, 2007

[iii] Pre Budget Report and Comprehensive Spending Review 2007 - www.hm-treasury,gov.uk/pbr_csr/pbr_csr07_index.cfm