Update

NHS Long Term Plan: a platform to transform cardiovascular care

With the new NHS Long Term Plan due soon, we reflect on how sustainable transformation in cardiovascular disease (CVD) care can still be delivered despite periodic NHS reorganisation.

5 December 2018, by Chris Annus

The imperative to deliver new models of care to provide a sustainable NHS is well recognised. Despite the barriers thrown up by regular change, transformational improvement in CVD care is still possible – and the BHF is ready to play its part.

The Five Year Forward View, published in 2014, proposed new care models across primary and secondary care and more integration with social care.

Fast forward to 2018 and the NHS is currently putting the finishing touches to its Long Term Plan for a sustainable NHS. This followed the announcement in June – coinciding with the NHS’s 70th birthday – of an average 3.4% per-year, real-terms budget increase in the next five years, starting in 2019/20. This was generally well received across the sector. 

The intention is now to build on the changes resulting from the Health and Social Care Act 2012, to continue developing new models of care and to expand on the opportunities that new mechanisms such as Sustainability and Transformation Partnerships (STPs) offer.

However, the NHS can sometimes be slow to adopt evidence-based approaches to improve clinical and cost efficiencies.

Challenges for innovation

New relationships and partnerships offer huge potential for more integration and efficiencies across the system. But in the short term, the creation of new structures, giving rise to mergers and highlighting workforce challenges, can pose a barrier to developing innovative new models of care. After all, structures – and staff – take time to bed in.

Over the past decade, the BHF has worked with NHS organisations to co-produce and pump-prime new care models, and to commission independent academic evaluations. These demonstrate the models’ clinical and cost efficiencies, reflect staff and patient experiences and show how these align with local and national clinical priorities.

As an independent charity working alongside the NHS, we’re in a unique position. We can be a catalyst for change, through pump-priming innovations, building robustly evaluated evidence and supporting the spread and adoption of new models of care. This allows us, through our innovation programme and the independent evaluations, to take stock of how innovation is delivered in practice – its challenges and potential mitigations.

New models of care

Our findings are consistent with a recent analysis by The King’s Fund and a seminal report by The Health Foundation and The Innovation Unit, which examined the required conditions in which to implement – and then scale up – new, innovative models of care.1,2 They also explored the challenges of doing so.

Favourable conditions included building the case for change using evidence and local health intelligence. Balancing fidelity with quality, but recognising adaptability and local context, is critical.

Although at times challenging, new structures can provide an opportunity to fundamentally reassess local priorities. It is a chance to bring about real system change across new organisations and regions. Clinical leadership is fundamental but so is communicating to all key stakeholders in a timely way. Developing and training the workforce to acquire new clinical skills to provide enhanced clinical care are also important. Traditional territorialism should be constructively and creatively challenged.

Retrospective evaluations

We have revisited our programmes to provide follow-up evaluation evidence covering over half a decade. We can now present proven approaches and case studies to drive innovation in CVD care. Most of these interventions succeeded and have been sustained despite the pressurised financial and operational context in which they were developed.

We now look towards the NHS Long Term Plan and the changes that will bring. The BHF has published five core priorities we want to see included – from tackling the big population health challenges to improving timely access to gold-standard treatments.

Looking to the future, health and social care integration could overcome many of the barriers to upscaling the adoption of proven healthcare innovations in the NHS. We await the launch of the Long Term Plan with interest.


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Chris Annus is Service Innovation and Evaluation Manager at the BHF.

This article was adapted from one originally written for the Best Practice Show 2018 Guide.

References

1  Adoption and Spread of Innovation in the NHS: The Kings Fund 2018
2  Against the Odds: Successfully scaling innovation in the NHS: The Health Foundation and Innovation Unit 2018