Professor Sir Mike Richards CBE, Director for Preventing Early Deaths at the NHS Commissioning Board, looks back at the NHS in the 1990s to see how much progress has been made in improving health outcomes since then.

1. Improving Outcomes in the NHS
Professor Sir Mike Richards
The King‟s Fund
November 2012
1

2. Improving outcomes in the NHS:
Overview
● A quick look back
 Where were we when the NHS was around 50 years old
(i.e. late 1990s)?
● What happened between 50 and 60 years?
● What is the NHS doing to improve quality at age 64
(i.e. now)?
2

3. The NHS in the late 1990s
● Pride and complacency were increasingly being
challenged (“we have the best health service in the
World”) as evidence grew to the contrary
● Very long waits across almost all specialties (cardiac,
cancer, A&E, orthopaedics, etc)
● Low investment compared to other developed
countries
3

4. The Liam Donaldson question (1999)
LD to MR at an NHS Executive Board meeting
“Mike, can you name me a single service which
has been failing across the NHS and which has
been turned around?”
4

5. The Liam Donaldson question - response
MR to LD: “Yes, cervical cancer screening in 1988”
5

6. The Liam Donaldson question - response
MR to LD: “Yes, cervical cancer screening in 1988”
LD to MR: “Ok, but what about a major service?”
6

7. The NHS between 2000 and 2010 (1)
● A period of
 Financial growth
 Strategies, national service frameworks, targets, etc
 New organisations (e.g. NICE)
 New clinical leadership (National Clinical Directors)
 New approaches to service improvement
 First steps on choice and competition
 Increasing emphasis on data to drive change
 New emphasis on quality
7

8. The NHS between 2000 and 2010 (2)
● Progress was undoubtedly made
 Workforce and facilities have expanded/improved
 Waiting times have fallen markedly (cancer, cardiac, A&E,
18 weeks, diagnostics)
 Service organisation has improved
• Multidisciplinary team working
• Coordination through networks
• Some reconfiguration (e.g. Cancer, stroke, vascular)
 Service improvement approaches are now better (but not
fully) established
8

9. The NHS between 2000 and 2010 (3)
● Improved data collection
e.g. National clinical audits
National Cancer Intelligence Network
● Improved accrual to clinical trials
• Through clinical research networks
● Improved safety
• Hospital acquired infections, VTE, intrathecal chemotherapy
● Reduced smoking prevalence (from 28% to around 20%)
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10. Progress on outcomes 2000 – 2010?
● Mortality from most of the „big killers‟ has improved
(cancer, cardiovascular, respiratory), but we could still
do a lot better
● Liver mortality is increasing, against the trends in
some other countries
● Diabetes in increasing and could have a major
negative impact on cardiovascular mortality
● Cancer survival in the UK still lags behind that in other
countries
10

11. ICBP: 5 year relative survival. Coleman et al, Lancet 2011
70
20
AUS CAN SWE NOR DEN UK CAN
AUS 18
65
AUS
CAN
16
SWE SWE
60
NOR 14
NOR
DEN 12
55
UK
DEN
10
50 UK
8
45 6
1995-99 2000-02 2005-07 1995-99 2000-02 2005-07
Colorectal Cancer 5yr RS Lung Cancer 5yr RS
90 45
SWE
AUS CAN
85
CAN NOR
40
NOR
AUS
DEN
80
UK
UK
DEN
35
75
70 30
1995-99 2000-02 2005-07 1995-99 2000-02 2005-07
AUS Breast Cancer NOR
CAN SWE 5yr RS DEN UK AUS Ovarian
CAN Cancer 5yrDEN
NOR RS UK

12. ICBP: 1 year relative survival. Coleman et al, Lancet 2011
90 45
SWE
AUS CAN SWE NOR DEN UK
CAN
85 AUS 40
SWE AUS
CAN NOR
80 35
NOR DEN
DEN UK
75 30
UK
70 25
65 20
1995-99 2000-02 2005-07 1995-99 2000-02 2005-07
Colorectal Cancer 1yr RS Lung Cancer 1yr RS
100 80
SWE NOR
75
98
CAN
CAN
AUS
70
AUS
96 DEN
NOR
65
DEN UK
94
UK 60
92
55
90 50
1995-99 2000-02 2005-07 1995-99 2000-02 2005-07
AUS BreastSWE
CAN CancerNOR
1yr RSDEN UK
AUS Ovarian Cancer 1yr RS
CAN NOR DEN UK

13. Progress on other outcomes 2000 – 2010?
● Patient experience is broadly static (though improving
for cancer patients, partly because it is being
measured and reported at team/service level)
● Quality of life for patients with long term conditions is
poorly understood as it is only measured in very broad
surveys
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14. Patient experience survey
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15. The NHS Outcomes Framework
Question:
How many people here today are confident
that they can name all 5 domains of the
NHS Outcomes Framework?
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16. Focus on outcomes
What would you want if you were seriously ill? Probably...
● To have your life saved (D1)
● To have a good quality of life thereafter (D2)
● To recover quickly from treatment (D3)
● To have a good experience of care (D4)
● To be treated in a safe environment (D5)
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17. Priorities for reducing premature
mortality (D1)
● Improving the NHS contribution to prevention of
ill-health (e.g. NHS Healthcheck)
● Earlier diagnosis: „Finding the missing millions‟
● Improving management in the community
● Improving acute services and treatment
● Preventing recurrence after an acute event
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18. Enhancing quality of life for people
with long term conditions (D2)
● Improvements in primary care
● Patient empowerment
● Coordination and continuity of care
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19. Helping people to recover from
episodes of ill health or following
injury (D3)
● Keeping people out of hospital when possible/desirable
● Effective working between primary and secondary care
● High quality efficient hospital care
● Coordination and support following discharge
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20. How will the new system deliver?
● Through...
 Clarity of roles within the new system
 Empowering commissioners
 Engaging clinicians and providers (e.g. through clinical
networks)
 Improving data to drive change
 Using financial incentives selectively
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21. New organisations and structures
● Department of Health (DH)
● Public Health England (PHE)
● NHS Commissioning Board (NHS CB)
+ Regions + Local Area Teams (LATs)
● Clinical Commissioning Groups (CCGs)
● Local Authorities (LAs)
● Health & Wellbeing Boards (HWBs)
● Commissioning Support Units (CSUs)
● New Improvement Body (nIB)
● Clinical Senates
● Networks (SCNs and ODNs)
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22. Summary
● We have come a long way on improving quality in the
past 10 – 15 years
● We still have a long way to go to equal the best in
Europe (or the World)
● The new focus on outcomes provides us with a new
opportunity, but it will not be easy – especially at a
time of financial austerity
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