On 1st June, in his role as Director of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London, SAM’s own Professor Derek Bell interviewed the Health Secretary Andrew Lansley on how he feels the new government can drive forward improvements to the NHS.
The interview is summarised below. For a full transcript see here.
Professor Bell: We know much about evidence based medicine, but less about evidence based implementation. How does the WP and bill reflect this and help solve the problems?
Andrew Lansley: In the NHS we didn’t have too much evidence on the service we are providing – but we want to know about the quality of service we are providing so we can monitor that.
We published the Atlas of Variation in December – and there were huge variations from 1.6 per cent to 5.8 per cent average for mortality following bowel cancer surgery. We know the publication of data drives improvements in outcomes – we need an evidence base and clinical leadership to drive this.
Professor Bell: What is your view on how to establish more effective, timely data for quality improvement?
Andrew Lansley: Some of it can be very contemporary – we’ve extended the reporting of healthcare acquired infections and we are doing this on a weekly basis, and expanded it – and the rate had dropped so we know that’s working.
So we’re shifting from NHS level data where months and months later we get the results, where now we’re getting patient experience data on measures like when someone presses the call button did people respond quickly enough – we are publishing this data in a straight forward way.
Professor Bell: How do you think patients and the public can get involved in the co-design of services, and generally be much more systematically integrated into improving quality, including the improvement of patient experience?
Andrew Lansley: We need to ensure that patient involvement in their own care is built into how the NHS works. Consortia and networks need to do more to involve patients. We need to make sure they are integral to how they work.
David Tucket wrote about the meeting of experts – the expert is the patient about themselves. If you want to design a really good stroke service you need patients because we need to know what services they are expecting and how we deliver them – it is about the needs and expectations of patients, and that is where the legislation will help them and help to integrate services.
Professor Bell: How do the proposed plans and new structures within the WP and bill balance collaboration and competition within the context of knowledge sharing and cross service collaboration?
Andrew Lansley: It is just about making sure you get the right service for patients. Now the patients themselves demand more involvement in the decision about who provides their care and what treatment they receive – does that give rise to competition, yes but as a means to an end, not an end in itself. I don’t know any healthcare system where clinicians don’t experience competition in the quality of their services they provide.
Professor Bell: Improvement Science is an emerging field to help establish a stronger basis for improvement. What are your views on the development of Improvement Science and the role of research in improvement?
Andrew Lansley: It is not for me to tell the NHS how it should apply the latest evidence on how to secure these improvements. David Cameron and I have been clear what we want in terms of outcomes for patients but we would let the NHS decide for itself how it would deliver it.
The key is leadership. When I sent to King’s Fund – I explained it is leadership at every level and closer to patients.
Professor Bell: Within our research programme, local LINks have helped drive improvement projects. Looking ahead to Healthwatch, how do you think this dimension of involvement help influence and improve research for improvement, and what are the differences with LINks?
Andrew Lansley: They should be the link to the CQC, and they should be directly linked in to what patients say about their care. They should have the ability to input into the Commissioning Board nationally and the consortia locally. They should be able to look at the needs of the local people in their area, alongside the local council. Health Watch should be able to say from a health perspective what we need to do to respond to the needs of local patients.
Professor Bell: Specifically Re: academic input into commissioning, with the new commissioning agenda how do you perceive the academic community contributing effectively to this and make the most of the new landscape?
Andrew Lansley: It seems clear to me from talking to people at academic health science centres that if you want to be the best providers of healthcare, putting research and innovation alongside clinical practice is essential. If commissioners are looking at getting the best outcomes they will work with more research based organisations to innovate.