Not quite an ocean apart: UK and US health challenges
Just down the block from 10 Downing Street, where the British political leaders continue to work towards a resolution on Brexit, I spent part of early October with the UK’s top health policy minds at the Public Policy Project’s 2019 conference: “Delivering Innovation in Healthcare and Life Sciences,” organised by World Healthcare Journal, Accountable Care Journal and Hospital Times.
Focused around the work by the NHS to transform the massive single-payer system for the 21st Century, there were both senior NHS officials and outside experts weighing in on the key issues facing the organisation. These issues included improving outcomes at scale, better meeting the needs of the ageing and more medically complex populations, building the workforce needed to deliver care and transformation for the digital age.
While we in the US might think the NHS is as far from a comparative model to the US health system as possible, what was clear from the day was that the two systems are more alike than different. While our funding sources differ, the NHS is facing the same structural challenges that healthcare providers in the US faces: how to improve health outcomes for populations at scale and reduce costs in the 21st Century.
Welcoming the group and setting the tone for the day, Stephen Dorrell, former UK health minister, delivered the key points. As kind as he was blunt, Mr Dorrell professed that “the NHS doesn’t have an innovation problem, it has a second adopter problem,” noting the tremendous innovation and creativity happening every day within its footprint. He added that these innovations are neither disseminated well nor easily adopted at scale.
Mr Dorrell also noted that the NHS must work across sectors more effectively. Look across country borders for solutions to tough problems, he said, and redefine the real goal of healthcare away from outcomes and towards broader societal metrics.
Insight from outsiders
The keynote address was delivered by Baroness Dido Harding, Chair of NHS Improvement, who comes to the NHS as a relative outsider. But with that comes significant insight about how other sectors learn, improve and scale, which will prove invaluable to the NHS as it moves forward its improvement agenda.
Baroness Harding centred on the fact that leadership, from Skipton House (the headquarters of NHS England), all the way down to local authorities and providers, must focus on “seriously learning how to work together,” reminding us all that the work of improvement begins with a strong set of skills and shared language. She also noted that the world’s best performing healthcare institutions have an improvement approach, which she coined “East Coast/West Coast,” in reference to the opposite US coastal mindsets.
By this, she was referring to the bringing together of the rigour of continuous improvement methodology (East Coast) with a healthy dose of West Coast love. Later on, when pressed to name an example of how she sees the system changing, she noted a recent clinic visit where she happened upon a group of nurses engaged in a 15-minute continuous improvement cycle. She was there to attend a high-level meeting but admitted that it is on the front line where you really see change taking hold.
Baroness Harding also spoke clearly and unequivocally about the need to work with other sectors in order to reach population health goals. “If you’re trying to genuinely deliver better health outcomes, you cannot ignore education, housing, local government and private industry,” she said. She pointed out that many examples exist on the ground in local communities, but that at the national level the government entities must continue to work to align themselves for maximum impact.
The social determinants of health
I was honoured to share the stage with a set of panellists who focused on air quality, both indoor and outdoor. They explained how using a framework of social determinants for health can help our systems understand how forces outside the four walls of clinics and hospitals can shape health outcomes and potential solutions.
What I appreciated most about the structure of the panel was that we had representatives from each key sector of the solution puzzle: Stephen Holgate, a clinical professor of immunopharmacology who studies asthma, respiratory illnesses, and the clinical impact of poor air quality; Paul Dawson, former VP of Health at Dyson, makers of air quality machines that people put in their homes; myself, bringing the perspective of how to structure productive cross-sector partnerships; and Rosamund Adoo-Kissi-Debrah, mother of Ella Roberta, a six-year-old who ultimately died of asthmatic seizures linked to poor air quality in London.
Together, we had a lively conversation about what it takes to address the social determinants of health, including air quality, how to engage public systems in the work of systems change and how policy can feed the movement.
While the conference offered an abundance of key lessons and interesting takeaways, what struck me most were the huge similarities between the key issues the UK’s NHS and the US’s multi-payer systems are facing. In short, the payer debate misses the key delivery challenges that even single-payer countries are facing. Here are some of the top common challenges and solutions I discovered:
- Scale as an inherent advantage and disadvantage: Both the NHS and the US’s large public programmes like Medicaid and Medicare serve huge populations over massive geographic boundaries, with thousands of providers. Scale remains a challenge (standardisation and the spreading of knowledge) as well as an opportunity (local innovation bubbles up, and flexibility in approaches).
- Working cross-sector as a strategy for outsized results: The era of silo-specific work is over; both countries see the huge opportunities in working together, but both are still struggling with how to do it, how to incentivise it and emerging best practice.
- Placing improvement at the foundation: Both the US and the UK systems have bought into the systems-level reforms needed, but they also share a commitment to using a rigorous approach to improvement. You’ll find IHI fans on this side of the Atlantic as well as back home.
- Data isn’t a panacea — yet: It was perhaps comforting to hear the same kinds of anguish around data use and confusion that I so often hear back in the states. Data, both big data and small data, remains a mostly unharnessed resource for the system and local providers.
Watch the full session here
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