In this article, Barbara Harpham, chair of the Medical Technology Group, looks at regional variation in healthcare and how regions and hospitals can learn from each other to improve care
A new report by the Medical Technology Group reveals that high performing hospitals are treating up to three times as many patients as consistently poor performing ones in London and the Midlands. Despite proof that the ‘postcode lottery of care’ has been entrenched by the pressures of the pandemic, this variation should now be seen as an opportunity to learn from the best.
If you want urgent treatment, the data from our latest report suggests you should probably move to Wakefield. This was the highest performing region during our eight-month investigation into where you could find the best NHS care in England. Looking at NHS patient referral to treatment data, we found that some areas of the country perform consistently better than others. Amid an ongoing crisis in resourcing, staffing and provision of care, it’s important we find out why this is the case.
Since 2019, we’ve been campaigning to raise awareness of the fact that all too often in the NHS, your level of treatment is dependent on where you live rather than what you need. However, a lot has changed since our original campaign in 2019. The health service is going through its worst ever crisis in the wake of Covid-19 at a time when it has transitioned to the Integrated Care System. Rather than frame regional variation as a problem, we wanted to champion and highlight those regions and hospitals that were succeeding against the odds. In analysing their success, we wanted to present their level of care as a benchmark all hospitals in the NHS are capable of achieving.
Our data analysis period was significant for a number of reasons. July 2021 to March 2022 saw hospitals begin to work in earnest through the backlog of care, tackle the spread of the Omicron variant, and work out the impact of the pandemic on an overworked, and all too often under-rewarded workforce. This was the re-emergence of the NHS from the pandemic before it fully transitioned into the integrated care model that in some regions had already been in operation.
This all added a layer of complexity to our analysis of the regions. It’s fair to say there are a number of factors that need to be considered when comparing different regions, such as varying levels of population density, different health population needs and the varying spread of Covid-19. To address this, we focused not just on those that performed consistently well, but also those that managed to improve their ranking during our data period. Some CCGs, for example Bury, rose dramatically while others marked consistently high performance where their neighbours continued to decline. What was at play in these hospitals? We decided to investigate.
The case is often made for the uptake of medical and data technology in the abstract - faster operations, more efficient use of staffing resources, better patient outcomes. It was refreshing to see it in action in places like Bury, who slashed their waiting lists using same-day, highly specialised surgical clinics that treated record numbers of patients. In Wakefield, data technology created a ‘shared referral pathway’, allowing doctors to communicate with each other often across primary and secondary care as the patient completed their pathway.
In examining the use of medical and data technology, something we’ve written extensively about in our reports, another factor also emerged: the leadership strategies and implementation of this technology which accounted for its varying degrees of success across the system. Put simply, management, human resourcing and clinical practices, despite NICE guidance, vary heavily from region to region. The use of medical and data technology was often only as good as the way in which it was utilised by management. In many instances, this best practice was years in the making and accountable to long-term health initiatives planned around specific treatments areas such as cardiology, orthopaedics and gynaecology.
Learning from the best
This all brings us to the question. How can we ensure that what is working best in the system is scaled out and replicated across the health service? The solution is quite clearly not a simple one. It rests on a degree of cooperation, but also understanding across different stakeholders that best practice can not be replicated overnight, but is often built into the ‘culture’ of one particular hospital or region. That said, strategies to level up, or even in some instances ‘raise up’ specific areas of the NHS which are chronically struggling, must be based upon this best practice. Observing what works well in the system and communicated effectively by fellow NHS professionals is tangible and not built on the abstract. It transforms the promises of the ICS: innovation, integration and population health into tangible management structures and procurement of technology. We need strategies built around this, with targeted funding for those regions to implement them.
Work to do
For this to happen, there is work for all three tiers of NHS management to do. Firstly, the Government must develop a national strategy to implement best practice backed up by a meaningful recourse to funding and action for those ICSs that continue to perform poorly. Our report and our case studies may serve as a start for determining this best practice, but if the government is going to continue to pump money into the NHS to recover from the backlog and deal with the workforce crisis, time must be spent ensuring it is being spent on proven solutions. Secondly, NHS England must work in conjunction with this strategy by developing better pathways to spread innovation. This is a particular priority given the new ICS model risks devolved health regions siloed on particular population health data. We should continue to believe that what works well in one part of the country should work well in another. Lastly, local NHS bodies and leaders must continue to procure and encourage proven medical technology and innovative practices, as well as champion best practice they find in their region. NHS variation is not just a regional one, but also a local one too, with hospitals barely ten miles apart treating twice as many patients in some instances.
As we prepare for another winter of misery, we must continue to believe that the NHS is capable of delivering a world-class quality of care. Indeed, there are many regions and hospitals that continue to fulfil this thanks to the endeavour and innovation of their staff. In a crisis, ways of working more efficiently and making the best use of resources have been forged. It is now essential that we back this innovation with appropriate funding, policy and commitment across all levels of the NHS.
Barbara Harpham is chair of the Medical Technology Group, a not-for-profit coalition of patient groups, research charities and medical device manufacturers working together to improve patient access to effective medical technologies.