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Health systems development; working in partnership

Updated 21 May 2014

1. Health systems development: central to expanding healthcare provision

Many countries are focused on improving their health system. They are seeking innovative ways of harnessing existing resources and making effective investments to improve health outcomes for their citizens.

2. Components of a health system

The World Health Organisation (WHO) has defined 6 building blocks of a health system which operate inter-dependently to support an integrated organisation.

Components of a health system:

• service delivery
• health workforce
• health information systems
• access to essential medicines
• financing
• leadership and governance

The UK has leading-edge expertise in systems development that, according to the Commonwealth Fund survey, makes the UK’s National Health Service one of the most efficient and effective health services in the world.

The survey found that of 11 high-income countries surveyed, people in Britain have among the fastest access to GPs, the best coordinated care and suffer from the fewest medical errors. The service substantially out-performs the USA on a per capita spend of less than half and is rivalled only by Switzerland in Europe.

“Keeping health systems on track requires ……. coherent investment in the various building blocks of the health system, so as to provide the kind of services that produce results” World Health Organisation

3. The UK’s capability in health systems development

Through its experience of developing and operating the NHS for more than 60 years, the UK has the know-how to partner with governments and other healthcare providers to support the design and development of first class healthcare systems.

Since the formation of the NHS, the UK has invested billions of pounds constantly improving the quality of healthcare available to its citizens, but it remains one of the world’s most cost-effective healthcare systems - the result of intensive collaboration between the NHS, commercial healthcare companies and academia to develop innovative, integrated, high quality and cost-effective systems of care.

The UK has a long track record of enhancing clinical services through analysis of how they are delivered and implementing solutions that provide better patient outcomes and improve efficiency.

The unique relationship between NHS providers and industry means that the UK has wide ranging expertise across the spectrum of healthcare provision and, through Healthcare UK, stands ready to apply its know-how to assist partners to develop any of the components of their health system.

This brochure highlights just some of the areas where UK expertise is contributing internationally to the development of health systems.

4. Clinical services design, commissioning and delivery

The UK’s clinical services and healthcare institutions are world leading, and are underpinned by first-class education, training and regulatory systems.

Designing and implementing services is at the heart of the NHS, which is constantly striving to improve patient outcomes and optimise the application of resources. British professional services businesses, academia and specialist organisations have worked extensively with the NHS and overseas clients to contribute to service development and reconfiguration to meet the growing demands of their health systems.

4.1 Whole health system redesign in the UK: KPMG

UK professional services provider KPMG worked with NHS Manchester to redesign its whole-health economy with the aim of improving sustainability and the care of patients with long-term conditions. Working with all the providers of health and social care, the challenge was to save 20 per cent of the Primary Care Trust budget by redesigning service delivery models and pathways to move patients out of hospital to more appropriate settings of care.

In this complex engagement with a large number of stakeholder organisations, KPMG facilitated the design of clinically led integrated care pathways supported by the modelling of the financial impact of the proposed service change. GP-managed referral gateways were created to improve patient outcomes while increasing the use of community care.

4.2 Health systems reform in Dubai: PA Consulting

The Ruler of Dubai, Sheik Mohammed, tasked the Executive Council of Dubai with the implementation of the Dubai Strategic Plan. The Council appointed UK professional services provider PA Consulting to define the blueprint for two of the most complex of the new authorities that will be part of the reform programme – health and social development.

Consultants from seven skill groups in PA, ranging from health, organisational change, strategy, international development and delivery contributed to this project. PA produced a one-page strategy for the organisations, developing the scope of the new organisation, the processes, the organisational design, and detailed implementation plans.

The team supported HR, finance and legal and IT working parties in the design of the future support services capabilities in the Dubai Health Authority (DHA), the agencies and the shared service unit based on input from Department of Health and Medical Services (DOHMS), consultation with other relevant stakeholders and best practice.

Equally significant was the cross-cultural nature of the working parties and the efforts invested in gaining buy-in from DOHMS colleagues, which contributed to building the detail necessary for the project and overall reform of the health system.

PA also defined the requirements for support during transition and the capabilities required by the transition teams and the current organisation. PA went on to draw up the detailed strategies and implementation plans for the various agencies agreed during the blueprinting and also create the detailed services implementation plans.

4.3 Reimbursement negotiation for Libya: PWC

During the revolution in Libya, the Transitional National Council (TNC), the opposing forces at the time, announced that they would pay for medical treatment outside of Libya. This was because a significant number of patients had crossed borders into Tunisia and Egypt to be treated, due to the deterioration in medical facilities within Libya as a result of the war. Hospitals in Tunis, Cairo and Alexandria were soon overwhelmed and other countries stepped in to treat Libyan patients. As a result, patients were flown out of Libya, Tunisia and Egypt to countries in Europe, Africa, Asia and America and to date have been treated in 45 different countries at a cost of $3bn.

The Libyan Ministry of Health (MoH) engaged PwC to assess the costs being charged in relation to Libyan patients and their accompanying family members, and determine any overcharging in the costs for medical treatment and accommodation overseas, prior to payment. Further to this, MoH also asked PwC to assist in negotiating discounts to be able to settle the outstanding debts related to the treatment of Libyans.

PwC quickly prioritised the countries to review and set up teams in Greece, Egypt, Jordan, Tunisia and Germany, utilising both local team members with local market knowledge and language capabilities, as well as experienced managers from the Middle East and UK offices to manage the review.

Where possible they obtained data from the hospitals and hotels to analyse the costs as efficiently as possible. Where this was not available, particularly given the situation in Libya when these patients were first admitted and therefore the lack of processes for collating such information, PWC developed alternative solutions to allow them to review and conclude on the costs being charged.

As a result of the reviews performed by PwC, the MoH has so far been able to settle debts in a number of countries, saving significant amounts. PwC are continuing to work through the reviews for each country, allowing MoH to settle debts and to set up resilient processes for payment of the ongoing treatment of patients.

5. Clinical guidelines and appraisal of new interventions

Healthcare is becoming ever more challenging. Access to up-to-date, trustworthy, evidence-based knowledge is critical if the best and most cost effective clinical decisions are to be made.

The UK is internationally recognised for the way in which technology appraisals are conducted and clinical guidelines developed. Recommendations are made based on a rigorous process centred on using the best available evidence using the expertise of the NHS and the wider healthcare community, including healthcare professionals, patients and carers, industry experts and academia.

5.1 National Institute for Health and Clinical Excellence

An integral part of the NHS, the National Institute for Health and Clinical Excellence (NICE) has been setting evidence-based best-practice standards for health professionals since its establishment by the UK Government in 1999.

NICE International

Over the years, NICE’s guidance and methods have generated substantial interest around the world from researchers, non-governmental organisations, health insurance funds and Ministries of Health and Finance.

NICE International was set up to offer advice and support on a not-for-profit, fee-for service basis to help countries provide clinical and cost effective healthcare to their populations.

Since 2008, NICE International has delivered hands-on technical projects in 14 countries, helping build capacity, adapt guidelines, develop clinical pathways and performance standards, carry out cost-benefit evaluations of interventions and technologies, and boost governance and transparency in decision making.

In another 36 countries, NICE International has engaged policy makers or formed partnerships with them.

5.2 China – improving health services for the rural population

At the request of the Minister of Health of China, and with support from the UK’s Department for International Development, the China National Health Development Research Centre (CNHDRC) and NICE International set up a project aimed at improving the quality and efficiency of health services for China’s rural population of more than 800 million people.

NICE International worked together with senior practising NHS and Chinese clinicians expert in medicine, surgery and epidemiology to pilot best practice clinical pathways in hospitals in the Shaanxi and Chongqing provinces.

The pathways aimed to address the problem of interventions and conditions that seemed to be driving up costs without improving outcomes, such as elective caesarean section and pharmacological management of hypertension.

Following the successful pilot, the approach is now being scaled up across more than 40 counties under the leadership of the Chinese Ministry of Health and CNHDRC.

5.3 BMJ Evidence Centre

The BMJ Evidence Centre supports healthcare practitioners and institutions by providing trustworthy information, in formats that recognises the demands and limitations of everyday clinical life.

The BMJ Evidence Centre’s clinical information specialists find, filter, appraise and summarise the best available research evidence. This is synthesised with expert opinion and guidelines to offer practical, innovative tools and services that acknowledge the different needs of students, researchers, clinicians and patients.

Audits and analysis help appraise and improve current performance and support clinical teams, managers and patients to implement change to achieve quality improvements.

6. Workforce planning to inform strategic decision making

As health systems and organisations develop and expand consideration of the future size and shape of the workforce, recruitment priorities and staff training takes centre-stage.

Developing capable, motivated and supported health workers is essential for overcoming bottlenecks to achieve national health goals, as is considering how the workforce must be mobilised to address specific health challenges.

6.1 The Centre for Workforce Intelligence

The Centre for Workforce Intelligence (CfWI) is the UK’s agency for workforce planning, contracted by the Department of Health from Mouchel Management Consulting. They consult with professionals and service planners and managers and analyse trends. They use this data to model future workforce needs, generate scenarios and scan the horizon for new possibilities.

Together, all three of these processes improve the quality of workforce intelligence so that it can better inform workforce strategy and planning.

CfWI are currently leading on horizon scanning for 34 European states and are active internationally, for example in Brazil and work in partnership with other organisations, including Manchester Business School and Serco.

7. Quality, compliance and governance systems

Governance systems address the structures, systems and processes that assure the quality, accountability and proper management of an organisation’s operation and delivery of service to patients.

The UK has a long history of developing and improving governance systems, pioneering the concept of clinical governance as a framework. Organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence flourishes. Other functions within health systems also required strong governance.

Quality and economic regulation are important features of the NHS. All NHS care providers must publish annual quality accounts which are subject to audit and have to meet set standards on governance, quality and risk. The NHS has a country-wide IT governance system to ensure patient and staff information is kept safe.

7.1 Independent hospital and clinic accreditation: The QHA Group

The QHA Group is a British-based healthcare company with a worldwide vision dedicated to improving quality and reducing risk for patients, healthcare providers and the general public.

Run by British clinicians and experts actively working within the NHS and private practice, QHA has considerable and long-standing expertise in a wide range of healthcare fields, particularly independent hospital and clinic accreditation.

QHA Trent has worked with hospitals and clinics of the Private Hospitals Association in Hong Kong, throughout the Philippines, United Arab Emirates, Cyprus, Malta, and Southeast Asia.

Using standards based principally upon UK NHS clinical governance (but with bespoke elements), and applied by experienced volunteer surveyors derived from medical, nursing, allied healthcare professional and managerial backgrounds, QHA Trent’s accreditation services work in partnership with hospitals and clinics located anywhere in the world to identify risk and maximise safety for patients, staff, visitors and the general public.

8. High impact changes

The 10 high impact changes for service improvement and delivery were first published in August 2004 and updated in 2007. They proved hugely popular with the NHS and healthcare organisations around the world, as staff grasped the opportunity to make major, far-reaching change in their organisations. The appeal of the 10 high impact changes was partly that they distilled ideas about innovation and improvement into a series of practical steps. It was also that they were rooted in the everyday experience and achievements of thousands of frontline clinical teams.

The high impact changes resulted in:

• reduced waiting times in Accident and Emergency departments,
• reduced waiting lists
• reduced inpatient bed stays as more elective surgery was performed as a day case
• improved productivity of outpatient departments by reducing unnecessary follow-ups
• improved reliability of therapeutic interventions,
• a more systematic approach to supporting people with non-communicable diseases.

The UK has continued to develop a range of high impact innovations that are leading to significant and sustained improvements in outcomes, quality, productivity and cost across the healthcare industry.

8.1 3 million lives

The Department of Health (DH) estimates at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services.

3 million lives aims to develop new business models in partnership with industry, encouraging greater uptake of telehealth and telecare and changing people’s attitudes towards them.

7 pathfinder sites have been established across England, each of which will procure a package of services with support from four UK trade organisations, TSA, Medilink UK, Intellect and ABHI to benefit 100,000 people in 2013.

This commitment alone already makes England the leading centre for telehealth outside the USA.

8.2 Providing care closer to home: Gloucestershire Primary Care Trust

In 2011, Gloucestershire Primary Care Trust (PCT) began implementing a fully managed telehealth service for 2,000 patients over a three-year period. The service is provided in partnership with Tunstall Healthcare. It includes a full time implementation team to support the deployment, clinical engagement, pathway optimisation and monitoring of the patient systems. This is the most successful and largest GP referring programme in the UK to date, with 88% of all GP practices in the PCT actively referring patients. Telehealth forms an integral part of PCT’s programme to provide more effective care closer to home, avoid unnecessary interventions and make financial savings

8.3 Productive operating theatre

The productive operating theatre initiative is one of a number in the Productive Series developed by the NHS to support NHS teams to redesign and rationalise the way they manage and work.

This helps achieve significant and lasting improvements, predominately in the extra time that they give to patients, as well as improving the quality of care delivered whilst reducing costs.

The Productive Series adopted efficiency techniques previously used in car manufacturing and safety techniques learned in the aviation industry and adapted them for the NHS in a practical and innovative way.

The process promotes a continuous improvement culture leading to real savings in materials, reducing waste and improving staff morale. The “releasing time to care” module of the series has been adopted internationally in the USA by CareOregon and in Canada by Saskatchewan Health Quality Council.

Since implementing the productive operating theatre programme, University Hospitals Bristol NHS Foundation Trust has saved £2 million as a result of reductions in waiting lists.

The Trust started the programme in 2009 having already reaped the benefits of implementing the productive ward programme.

The saving was achieved by careful rostering of consultant time, effective team job planning and a six-week forward look at the theatre schedules which removed the need for waiting list reduction initiatives requiring additional payments to staff.

8.4 Reducing the impact of healthcare acquired infections using real-time surveillance: ICNet

Reducing the impact of healthcare acquired infections and minimising the potential for the development of more drug-resistant bacterial strains are important concerns for healthcare providers across the world.

ICNet, a British company which has been developing healthcare information communication systems for over thirty years, provides web-based surveillance systems to aid infection control. Monitoring systems which are impossible to achieve through manual methods alert clinicians and managers to specific infection risks and emerging patterns as they arise.

Linking laboratory results with patient records enables real-time monitoring of antibiotics which clinicians use to improve their antibiotic regimens. This reduces the risk of developing drug resistant bacterial strains and lowers the spend on antibiotics.

The ICNet systems are used in over 1,000 hospitals globally, with national contracts in New Zealand and Scotland. Systems in local languages are operating in China, South Africa, Malaysia, France, Germany, Canada and the USA.

9. Why choose UK companies and organisations as partners for health systems development?

UK organisations have an exceptional perspective on how to orchestrate healthcare for large populations and provide patient-centred, cost-effective care.

The unique relationship between NHS providers and industry means that the UK has wide ranging expertise across the full spectrum of healthcare provision and works with Governments and healthcare providers around the world to share know-how and contribute to local health systems development.

The UK has a long track record of enhancing clinical services through analysis of how they are delivered and implementing solutions that provide better patient outcomes and improve efficiency.

The UK’s reputation for a rigorous approach to quality, compliance and governance is renowned around the world and the experience of UK agencies and organisations is available to assist other countries to develop their own systems.

To find out how Healthcare UK can assist you to access the expertise available within private companies, the NHS and academia, please email us at healthcare.uk@ukti.gsi.gov.uk