On Wednesday the government’s Spending Review confirmed that an additional £3.8 billion would be made available for the NHS in 2015/16. That is welcome news – but with cuts to social care and public health, this is robbing Peter to pay Paul. On top of that, the health service still needs to make £22 billion of efficiency savings by 2020/21 – something it has not achieved in its history.
The previous week, the 50 vanguard sites developing new care models of care across England met in London to take stock after their first 200 days. Never has their main aim been so urgent – to develop more integrated systems of care that meet the needs of future patients.
NHS trusts are regularly missing their waiting times targets and winter pressures are yet to hit A&E departments. The NHS needs inspiration and it needs it fast.
The good news is that we know that transformation is happening successfully in other parts of the world. Last week, The King’s Fund published its report, sponsored by Cerner, of Southcentral Foundation’s health system for Alaska Native people in Anchorage, Alaska. In the mid-1990s, Southcentral faced many challenges: GPs coping with 40 or more appointments per day, hospital services close to breaking point and waiting times spiralling out of control.
Twenty years later, Southcentral has close to eradicated waiting times. Health outcomes are among the very best in the United States for a population with high levels of need. All of this accomplished with fewer doctors and nurses and declining funding per capita. Quality is up and costs are down – the ‘Holy Grail’ for health systems around the world. But how was such a turnaround achieved?
Southcentral’s senior leadership spent their first four months with clipboards in clinic waiting rooms asking service users what they really wanted from their health services. After this, they drew up a set of ‘requirements for an ideal health system’. Then they ‘changed everything’.
Over 10 years, they transformed how doctors, nurses, medical assistants and administrators work together to deliver primary care services. They also fundamentally changed how primary care teams work with hospital doctors in an integrated system of care.
The results? Southcentral moved from four-week waits to same-day access for routine primary care appointments within less than a year. It achieved an approximately 35 per cent decrease in face-to-face appointments with GPs from 2008 to 2015. In the first years of transformation, A&E visits dropped by more than 45 per cent and hospital admissions by 53 per cent. Customer satisfaction and staff satisfaction with the system are now well above 90 per cent.
In our case study, we describe in some detail Southcentral’s transformation journey as well as where it is currently. Alongside discussing Southcentral’s model for frontline services, we explore the vision, values and behaviours, the information systems, data, analytics and performance benchmarking, the human resources processes and the investments in the workforce which have allowed Southcentral to sustain its model across multiple teams and over time.
Cerner provides Southcentral’s electronic patient record and population health system. We are grateful to them, both for helping to establish our relationship with Southcentral and for commissioning this research.
For the full report, and video interviews with Southcentral’s leaders and staff, see: Southcentral Foundation's 'Nuka' system of care.
This blog post was written by Ben Collins, Project Director at The King’s Fund.