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Operational Research, Workshops and Events

OR Society Blackett Lecture 2014: Opportunities and challenges for the NHS

2014-11-26 18.00.02 (Custom)This evening’s Operational Research Society Blackett Lecture at the Grocers’ Hall, London, was given by Professor Sir Bruce Keogh who is National Medical Director of NHS England.

The NHS faces unprecedented challenges as a consequence of increasing demand, escalating treatment costs and rising expectations in a tight financial climate. Addressing these issues demands an understanding of efficiency and value in our healthcare system.

Improving clinical outcomes and patient experience of care is at the heart of what leaders and managers of the NHS are asked to do. Achieving this goal requires clinical leadership and best available clinical evidence. It also requires richer data and the expertise of the social and management sciences, including Operational Research.   Bruce argued that quality improvement AND cost reduction were possible simultaneously (just like happens in the private sector) and said everyone in the NHS should “think like a patient and act like a tax-payer”.  That would seem to be a good starting point for improvement!

The lecture described some examples from Prof Keogh’s own experience in working in the NHS in recent years of bringing together clinicians, data and analysis to help understanding of how to improve outcomes and patient experience. The lecture focused on examples in urgent and emergency care, where interdisciplinary collaboration between clinicians, operational researchers and economists is helping us to understand how the very complex emergency care system might respond to rising demand for services. The tools being devised to promote and reward implementation of better models of care are already producing demonstrable results for patients with major conditions, such as trauma, stroke and a range of other services.  Bruce presented some interesting data on the impact of re-shaping Stroke Services in London.  These had been rationalised into fewer centres, but with more expertise and this had resulted in a 30% improvement in survival rates over a 2 year period.  This was against a background of “popular protest” that more people would die in ambulances.  A similar approach is being taken on major trauma units around the UK.  There is clearly some impressive work going on in the NHS, but it struck me that the organisation is not really succeeding in explaining the reasons for changes, or their benefits, to the general public.

He also spoke about his experience as a Cardiac Surgeon and his feelings about NHS targets.  He said judicious targets were good, but non-judicious ones were bad (!). On balance, he felt that the impact of the 4 hour A&E waiting time target had been positive because it had focused attention on not just A&E processes, but the wider system that has to change if A&E is to succeed.

Some of the most revealing information was the ranking of worldwide health systems, where the UK NHS came out Number 1 overall, and was No. 1 against most of the assessment criteria.  One sharp-eyed member of the audience spotted that the UK scored particularly poorly (Rank 10) on “”healthy living” and asked a question about the likely impact of that.  Bruce discussed Diabetes as one example and said there needs to be a much greater focus on preventive actions, otherwise the NHS will continue to struggle to find the capacity to cope with demand.

Interestingly, Bruce had started the lecture by speaking about Patrick Blackett who was an English experimental physicist known for his work on cloud chambers, cosmic rays, and paleomagnetism.  He was described as a Sailor, Scientist and Socialist.  In the Navy, he worked on improving gunnery devices and became interested in science and evidence-based decision-making.  One example quoted was when he was asked whereabouts on aircraft should additional armour be placed.  Conventional thinking was to add it to the damaged areas based on aircraft that had returned. Blackett turned this on its head and said the armour was required on the undamaged places, arguing that the planes that hadn’t returned may well have been hit in those places.  A great example of lateral thinking.  In 1940 Blackett became scientific adviser to Lieutenant General Sir Frederick Pile, Commander in Chief of Anti-Aircraft Command and thus began the work that resulted in the field of study known as operational research (OR).

Sir Bruce Edward Keogh, KBE, FRCS, FRCP, (born 24 November 1954) has been Medical Director of the National Health Service in England since 2007 and National Medical Director of the NHS Commissioning Board (NHS England) since 2013.

The Blackett Lecture was being filmed, so no doubt you will be able to watch it here.

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