Thursday, 30 October 2008

NHS system reform

I am not sure when the term “system reform” was first used but the first full description of the scope of “NHS system reform” was set out in the document “health reform in England: update and next steps” in 2005.

NHS system reform refers to a series of specific policies that taken together attempt to describe a coherent redesign of the whole NHS system to boost efficiency and responsiveness of services. It heralded a move away from centrally driven targets, the astute readers amongst you will know that the “t” word doesn’t figure in the Renal NSF, to a system designed to help encourage the NHS to be “self improving”.

The health management specialist library, part of the national library for health provides a detailed update on NHS system reform collating the various studies, commentaries and reports. It is a great place to start if you want to get your head around the big picture – what was intended, what has been achieved and what we have still to do. There may be those who view system reform as akin to the cultural revolution in Red China but its basis really lies in the information revolution. Information and the new technology are essential for each of the 4 pillars which are:

  • Demand side reforms - including patient choice and commissioning
  • Supply side reforms – including alternative providers (private and voluntary sector) and Foundation Trusts
  • Transactional reforms – chief amongst these being payment by results
  • System management reforms - particularly changes to the regulatory environment.

The conceptualisation of the reforms as “demand” and “supply” side, terms borrowed from the private sector, seemed a little awkward or uncomfortable initially for those of us who had grown up in the old NHS. But one of the striking changes in the last decade has been the move to industrial principles in UK healthcare. From clinical governance, through lean approaches to the safety analogies with the aircraft industry we are taking concepts from other spheres of activity and using them to promote quality in healthcare.

The health management specialist library update has lots to interest those promoting better kidney care. Kesh Baboolal (Consultant Renal Physician, Cardiff) has an article entitled “the cost of renal dialysis in a UK setting: a multi-centre study. Nephrology, dialysis, transplantation 2008” that is the number one article in the Payment by Results section. Commissioning safe and sustainable specialised paediatric services, that Jane Tizard (Consultant Paediatric Renal Physician, Bristol) helped author gets a mention in the Commissioning section and there is much, much more – some positive, some critical. Be informed, read it at the Health Management Specialist Library.