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Service redesign should be tested as rigorously as new treatments, NHS chief says

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3744 (Published 05 June 2014) Cite this as: BMJ 2014;348:g3744
  1. Tom Moberly
  1. 1BMJ Careers

Changes in service delivery should be subjected to the same rigorous testing as new treatments undergo, NHS England’s chief executive, Simon Stevens, has argued.

Speaking at the NHS Confederation’s annual conference in Liverpool on Wednesday 4 June, Stevens said that the NHS “should be rigorously pro-research” and suggested that such an approach could enable the NHS to become a world leader in health service innovation.

The NHS had a poor record of evaluating service changes, he told delegates. The service now needed to “accelerate the redesign of care delivery” through “some well controlled experimentation.” He explained, “We don’t apply the same discipline to the way we go about innovating in our service delivery that we would expect clinical professionals to apply in their own workplace. We do too many pilots that are not rigorously conceptualised and effectively managed.”

The NHS’s new “integrated care pioneers” programme (www.england.nhs.uk/2013/11/01/interg-care-pioneers) would benefit from more stringent testing, Stevens said. “What I would really like to see is a more quasi-experimental model of that and say, ‘This is the intervention; this is the hypothesis about what we’re going to do; this is the control or what the comparisons are going to be,’ and actually get much more quantitative about how we do new things in the NHS.

“I think that if we do that we’ll actually get a lot more from our clinical partners than if we just try to do the ‘latest and greatest.’”

The NHS had an opportunity to “offer something to the world” in terms of health innovation, he added. “We are never going to be the country that pays the highest prices or that adopts new treatments regardless of how well they work, just so we can say we’re innovative. We’ll happily leave that accolade to others. But what we should be is rigorously pro-science, pro-research, and pro- the rapid spread of useful improvement.”

He said, “The NHS potentially is a unique combination of biomedical research, population orientated primary and specialist care (serving distinct patient groups), longitudinal data . . . an aligned financing system, and a rigorous focus on value creation. Those are the ingredients that are going to be needed for this revolution; and actually the NHS could be the place on the planet where we really seize that.”

Stevens also argued that if the NHS were to “get smart about commissioning” it would need to examine its use of incentives. He pointed out that NHS England was currently expecting to spend up to £2.7bn (€3.3bn; $4.5bn) a year on performance incentives for community and acute providers. “We’re going to be undertaking a very hardnosed look at what we’re actually getting for that money and whether we can do better. More broadly, across all NHS funded services I’m going to be pushing for a steadily increasing proportion of payments that are tied to performance, quality, and outcomes.”

Notes

Cite this as: BMJ 2014;348:g3744

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