Plan B for the NHS

Devising Plan B for the NHS
Dr Margaret Hannah
Deputy Director of Public Health, NHS
Fife
IFF Fellow
www.internationalfuturesforum.com

Founding of the NHS
“Every man, woman and child can have
the benefit of this service. It is there for
rich and poor alike. We are paying for it
out of taxes”.

Founding of the NHS
• Designed for disease patterns of 1948
• Relatively simple system of healthcare
• Provided a service from cradle to grave
• Designed to reduce demand by improving
health.

Now we have concerns
• Costs have risen sharply
• It is proving hard to maintain equity and
fairness
• The change in demography and disease
patterns is putting increasing strain on
services
• Demands and expectations continue to
rise

Now we have concerns
• Populist politics stifles the long-term
strategic direction
• People are not aware of the real cost of
the services they receive
• We base our decisions about the NHS on
an assumption that we live forever
• Vested interests drive the agenda

Real percentage increase in spend on NHS from 1950 to 2010
Source: Institute of Fiscal Studies 2010

Current strategies to contain costs
will not work
• Financial Efficiency
– stripping out costs without strategic direction will
hasten collapse
• Managing demand
– off-setting costs onto other agencies and families has
reached its limits
• Prevention
– worrying uncertainty around effectiveness and
timescales
• Innovation
– to improve on existing system or design a new one?

Tony Beesley – in Beyond Survival, International Futures Forum, 2009

IFF Three Horizon Model
increasing
synchronous
failure
Innovation to try
and keep things
going
new context for
useful old ways
less
disruptive
change
new paradigm
fits and takes off
TIME
THE TURBULENT TRANSITION
HORIZON 1
HORIZON 2
HORIZON 3
VIABILITY
radically
different
operating
environment
NOW

Plan B for the NHS
• Stretch ourselves to imagine a third
horizon
• Look for examples of this already
happening
• Review our innovation effort
• Decide what we need to keep
• Let go of the rest

Third Horizon for Plan B
• Health is what it takes to make life worth
living and is rooted in everyday life
• Health has physical, mental, emotional
and spiritual dimensions
• Health includes illness, disability and
death as part of a bigger life-death-life
process in which we all participate
• Illness and death challenge us to grow as
human beings

Third Horizon for Plan B
• Majority of treatment, care and recovery takes
place outside acute hospital settings
• Lay support, holistic clinical help, pervasive
technology combine to provide highly effective
care and treatment in the community
• This care is safer, more effective and more
homely than hospital
• Builds community resilience and capacity to take
care of itself
• Shifts power relationships from clinicians to the
public

The Alaskan story
• Complete system redesign based on Alaskan
Native values
– > 40% decrease in A&E and emergency admissions
– > 50% decrease in specialist care (out-patients)
– > 20% decrease in visits to primary care
– > 35% decrease in admissions and length of stay
• Improved health outcomes
• Improved satisfaction indicators – “customer”
and staff

“What drives the system is belief”
• Medical Model has not been questioned in 100
years
• ‘Healthcare’ built on one philosophy yet its span
is so huge
• Grown a system beyond recognition since 1948
– but not the basic healthcare paradigm
• Professionals in charge, patients passive
recipients of care

Plan B for the NHS
• Aim for most advanced technology but
within the context of holistic care
– We grow a new generation of healthcare
practitioners who “work with both hands”
• Plan for anything, not everything
– Common to all healthcare interactions is the
relationship
– “People have diseases, diseases don’t have
people”

Plan B for the NHS
• Face the future with courage
– This next few years will not dismantle but
transform the NHS in Scotland
– “The end of the world as we know it but not
the end of the world”

Plan B for the NHS
• We all have a part to play
– Patients as active participants
– Clinicians as coaches, mentors
– Managers as designers for transition
– “Re-designing the plane whilst flying it”
– Politicians in having honest debate

Plan B for the NHS
• There is no easy technical fix
– This is a culture change
– Cant plan this journey, but can learn our way
into the future

Acknowledgments
• Participants at “Plan B” workshop
• Promising Pathways Group, NHS Fife
• Team from SCF, Alaska
• Andrew Lyon and Graham Leicester, IFF
• David Reilly and Phil Hanlon, “Fifth Wave”
• NHS Education Scotland and Joint
Improvement Team, Scottish Government
Health Department

Plan B for the NHS

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