NAPC News 13 August 2012

Thought For This Week - Is There An Olympic Legacy For The NHS

The Olympics – what an extraordinary success. What are we going to do with ourselves after they and their Paralympics counterparts are gone? Messrs Cameron, Johnson and Coe will all see the Olympics as not only as mission accomplished, but an extraordinary success in showcasing Britain.

What all of us know, of course, is that the success of the best events comes down to meticulous organisation. What the Games demonstrated was how good British management is when it’s asked to apply itself to a specific project, pull out all the stops and then deliver. Now, in retrospect, we can marvel at the behind-the-scenes planning. It was all organised in extraordinary detail. Are there any lessons from the Olympics which can be transferred to the NHS? As insights, let me give you just three little personal experiences which I encountered.

The doorbell rang while I was doing my emails one morning a couple of months ago. Already, one of them had just informed me that I should expect delivery of my Olympic tickets today. I go downstairs and at the front door is our regular postman with a package. I sign in the panel on his handheld receiver, put the tickets behind the clock and go straight back to my emails. Already, there is a message from the Olympics organisation which says that my tickets had been delivered and if I hadn’t got them would I proceed to a security check. All in the space of less than five minutes.

I can’t tell you how many years I’ve been complaining about how long it takes for hospital discharge summaries to reach GP practices. Why does it take days or weeks, or sometimes not happen at all? Why don’t we deploy the same kind of technology they use in the Olympics or across the package distribution industry? Are Olympic tickets more important than my mother’s hospital notes? Should packages have better care than people? I think if I were a commissioner, the least I’d do is use next year’s provider contract round to mandate the use of this technology to help solve the problem.

The second experience was the Olympic people: the help which was there all along the way to guide you to the right place. I know there were too many, that it was ridiculously over engineered. But what struck me most powerfully was the quality of each encounter. Every contact was friendly, delivered with a smile and designed to satisfy to the nth degree. I liked the way the FT put it, ‘Warm welcomes, helpful directions, cheery goodbyes. Not plastic or anodyne interactions, but help powered by a pride and desire to be part of something bigger, that any consumer facing business would kill for’. It’s what Disney recruiters call ‘magic dust’, having customer service people go the extra mile, be almost desperate to please. Now, I know from personal work experience (the AA, American Express, Bupa), this situation doesn’t rely on just choosing the right people. If you want an everyday example of people working sympathetically in with high volumes of people, pop into a Pret-a-Manger. It’s about a management culture hard-wired right through to the employees. To put all of this into perspective, isn’t the NHS one of the world’s largest consumer facing businesses? Doesn’t that then make customer service a key competency? And can it learn something from the Olympic experience?

Opportunity number three. NHS Choices is slowly getting some traction. Not only is it a patient benefit, but also it’s a fundamental part of DH policy to get the consumer involved in re-working the supply side of health care. For the present, in the absence of quality information about the medical process, many people just default to making their choices on factors such as access, transport and cleanliness.

My view of the medical encounter – take a hospital outpatient appointment as an example – is what happens during the entire day from when my front door opens to when I get back home. For many patients, often the most daunting part of the day is the journey, the logistics, the possibility of getting delayed or lost, or not having the right money for the parking. Many of these events can create their own anxiety for the patient and be detrimental to the treatment plan.

The Olympics organisation obviously gave event access a lot of thought. Their response was to provide a ‘free’ London Transport Travelcard with every event entry ticket. I guess this was to encourage me to go by train, but it was also a significant cost saving for my family.

Now what if every hospital appointment in London was accompanied by a free taxi voucher? The patient could go to any London hospital as part of his or her Choice entitlement. Transport would only be a very small part of the episode cost. But through this single move you could destroy the London village hospital legacy and the historic referral patterns built around them. People would start to think about going to the hospital which seemed right for them, even if it meant extending their journey time by 20 minutes or so. Also, they’d arrive unflustered, better prepared to deal with their treatment.

What providers would then start to work out would be whether they wanted to specialise in certain conditions or procedures. Working for many London PCTs, I’ve often wondered why nearly every London hospital seems to do about 300 simple hernia operations every year, that’s one a day for each. In Toronto, Canada, for many years they’ve had a metropolitan hernia factory which just does the one procedure, about 8,000 annually, with a fantastic quality record.

The opportunities for care rationalisation – and potential cost savings – could be extraordinary for a city like London. And as patients become active consumers and advocates, quality will also go up. If I were the chief executive of a London hospital (they don’t have chief marketing officers), I’d spend some time revisiting my Service Line Analysis and working out which potential patients I wanted to reach out to, and then create the incentives to win their Choose and Book referral. For the commissioner, there are many benefits as well. Just a small one would be the productivity gain of reducing DNAs. I ran a similar scheme in Boston in the US many years ago for organising the medical checks for diabetes sufferers. Giving each qualifying patient a free taxi ride more than paid for itself when measured by the long-term health outcomes, and the scheme is still operating today.

LOCOG quite clearly put its most creative brains to the design of the systems behind the Games. We know it all worked marvellously. I just wonder if we could bring some of the same brainpower and original thinking to the NHS. Now that would be a real legacy.

Roger Hymas (Director, Healthcare Commissioning Services Ltd)

Better Care For Over 65s Would Save NHS £462m

The King’s Fund said the NHS could manage with 7,000 fewer emergency beds if all areas of the UK could reach the standard of the best units in keeping the over 65s out of hospital.

Distressing hospital stays could be cut by 2.3 million a year, freeing up 7,000 beds, about one in 16 of the NHS total.

Fears For Patient Safety As Thousand More Face A Long Wait In A&E For Hospital Bed

Many more patients are waiting longer for a bed to become available in hospital A&E departments compared with last year.

The number of people waiting more than four hours in accident and emergency departments has risen by a third. In the first six months of this year, 66,845 patients waited between four and twelve hours for a bed once a decision had been taken to admit them, according to Department of Health data.

Tim Curry, assistant head of UK nursing at the Royal College of Nursing, said that the increase in waiting times reflected financial pressure at a time of restructuring and reform.

The Way Reduce Prostate Cancer Rates - Diagnose It Less

Prostate cancer diagnoses do more harm than good, according to Chris Parker, of London’s Royal Marsden Hospital, who said the annual ‘toll’ of 40,000 cases diagnosed could be reduced by 10,000.

Writing in the British Medical Journal, Dr Parker said: ‘The standard of care for low-risk prostate cancer should be watchful waiting [regular monitoring], which raises an important question: if low risk prostate cancer does not need treatment, then does it need to be diagnosed at all? In future, we need to focus on avoiding not just the treatment, but also the diagnosis of low-risk disease.’

Statins Key To Longer Life

Potent statins taken by millions of Britons can help people live longer and slash the risk of an early death, the latest research has found.

A new study has found that although statins slightly raise the chance of some at risk patients developing diabetes, the benefits of the medication in reducing the likelihood of cardiovascular disease far outweigh any risks.

Experts at Brigham and Women’s Hospital in Boston, Massachusetts, analysed data gathered during the Jupiter trial, which was the first controlled study to show that statins increased the risk of developing diabetes.

Professor Paul Ridker, who led the team of scientists, said he hoped the results would ‘ease concern’ as they showed that the ‘absolute benefits of statin therapy were greater than the hazard of developing diabetes.’