Healthy competition

Embargoed 0001 hours Tuesday 28 February 2012

This report presents ten case studies of successful health reform. Each case study shows how a radical change in the delivery of healthcare can result in improved quality and productivity.

The case studies show that successful health reform leads to:

Reduced costs through integration and competition

• In Rhode Island, a private company, Beacon Health Strategies, has created an integrated care pathway for mental healthcare services, which were previously highly fragmented. In one year, the cost of mental healthcare hospitalisations for children was cut by 20 per cent.
• In Massachusetts any willing providers were invited to organize community services for low income elderly patients. Patient-centred care management replaced uncoordinated services reducing the number of nursing home admissions by 32-42 per cent.

Reduced costs through standardisation of clinical practice

• In the United States MinuteClinic has developed strict protocols for a range of routine services. This has allowed the clinics to use nurses instead of more expensive doctors, enabling them to provide consultations 30-50 per cent cheaper than a visit to a GP.
• The Indian specialist maternity hospital LifeSprings has focused on providing a limited number of procedures and used standardised clinical protocols. Doctors’ productivity is four times higher than non-specialist providers and prices are 30-50 per cent of market rates.

Greater patient safety through service reconfiguration

• In Finland, the Pirkanmaa region closed joint replacement departments in five hospitals and concentrated care at one specialist hospital. The new hospital delivered complication rates below 1 per cent compared to an average of up to 12 per cent for general hospitals.
• The NHS in London moved emergency stroke care from 34 general hospitals to 8 specialist units with dedicated staff. London now has the highest standards of stroke care of any major international city.

Greater patient safety through better data

• Birmingham University Hospitals took the initiative to develop its own IT infrastructure to track medical errors and provide decision support to front line clinicians. Medication errors were cut by 66 per cent and contributed to a 17 per cent drop in 30 day mortality.
• The Cleveland Clinic in Ohio has published its clinical outcomes and data used by the hospital leaders to manage productivity, benchmark clinicians and improve quality. The hospital is one of the highest ranked in the United States for quality but costs are half those of equivalent providers.

These case studies bear directly on the current UK health debate. The passage of the Health and Social Care Bill has led to a polarisation in the debate between those in favour of change in healthcare and those in favour of the status quo. This evidence shows that the supporters of change are right to make that case. As David Cameron said in May 2011: “There’s only one option we’ve got – and that is to change and modernise the NHS, to make it more efficient and more effective – and above all, more focused on prevention, on health, not just sickness. We save the NHS by changing it. We risk its long-term future by resisting change now.”

But it is not enough to support “change” of any kind. This evidence suggests that the Government:

• continues to promote open data, building on the efforts of the Cabinet Office in particular.

• changes its various policies which have made service reconfiguration more difficult.

• updates its position on competition which has become equivocal.

• releases its central controls on the health workforce.