Opinion Article by Vivek Patkar, Chief Medical Officer, Deontics.If the recent publication of the Atlas of Variation shows the human costs of unwarranted variation across the NHS; then The Kings Fund's Better Value in the NHS report showed the financial cost.
The Atlas showed that across the country four out of ten patients are not being admitted quickly to a specialist unit, despite NICE guidelines making it clear that they should. The King's Fund has forecast that reducing such unwarranted variations in care can help clinicians deliver quality care but with the same resources; as Secretary of State Jeremy Hunt has said, good care costs less.
Too often there is a focus on short-term cost cutting measures. We should not focus on cutting costs, but rather focus on improving care. This can mean that short-term costs go up, but in the long term, patients and the NHS will benefit.
For example, with diabetics, if you are using effective drugs, and you are screening the patient and detecting something early, your short term costs will go up. But then you are preventing long-term complications. This saves money in the long run.
The King's Fund report echoes this fact, showing how positive change has come about over time when stroke care was redesigned in Plymouth. By understanding what was happening, and working with staff champions, the number of transfers to the stroke unit were 12% faster, and length of stay had fallen by 6%. Beds could be closed, and costs reduced.
The report noted that the delivery of such value came about when clinical, cultural, policy, economic and technological drivers are aligned.
I believe the latter is the most important, as this is the one that can support a patient across the entire clinical pathway, and so add the most value.
Real-time clinical decision support technology can enable healthcare providers to promote evidence-based care so the right decisions are made at the right time. Even a small change can translate into a huge benefit to reduce unwanted variation.
Unexplained variation is a symptom of inappropriate care. Take breast cancer, for example. A recent study examining the treatment patterns and breast cancer survival among breast cancer patients treated in ten east England hospitals, reported significant inter-hospital variation in five-year survival (ranging from 68 per cent to 77 per cent). It concluded that variation may be attributed to a lack of information.
A recent report looked at heart failure and other common conditions. This showed that, after 18 months of incentivised measures for hospitals to use best practice, 890 lives were saved, alongside 4.4 million pounds. Imagine the magnitude of the savings we could make if we consistently applied best practice across different conditions.
Variation is not always bad, of course. Sometimes there is good variation, and people need care specific to their condition. We need to get the right balance between standardised best practice and the personalisation of the care.
The crucial issue is to separate the bad variation from the good, and we have the technology that can handle that.
By providing real-time access to best practice at the point of care and as part of clinical workflow, we can support the clinician in making the best decision to support an individual’s care needs. Using a clinical computer language called Proforma, and implementing artificial intelligence so that the technology can learn from others on the best approach, we can now relate this to a patient’s data, and turn it into something meaningful for clinical use.
Not only can this help patient safety, providers can also focus their resources on where they need to improve outcomes. You get a more detailed insight into the problems surrounding inappropriate care, such as where variation is adversely affecting outcomes.
The evidence is out there; we can deliver better value in the NHS by reducing unwarranted variation. Technology and a paperless NHS can help make this a reality.
Mr. Vivek Patkar qualified in 1995, having studied medicine at Grant Medical College in Bombay, India and then undertook postgraduate training in General Surgery at J.J. group of hospitals and Tata Memorial hospital at Bombay. He was trained as surgical oncologist and subsequently as breast surgeon at Tata Memorial Hospital between 1997-2003.
Vivek moved to London in 2003 to pursue further research in breast cancer. After briefly working as a senior breast registrar at Guy's hospital, he joined the Advanced Computation Lab in Cancer Research UK, as a research fellow to undertake research in the field of Cancer Informatics.
Vivek's research focus is application of advanced cancer informatics to support evidence-based decision making. The work resulted in many publications, development of clinical applications and a commercial spin-out from UCL, Oxford and Cancer Research UK.
Vivek is a founder member and CMO of Deontics Ltd, a spin-out company from Oxford, UCL and CRUK. Vivek continues his clinical practice as part time at Whittington and Royal Marsden Hospital.