Time to save lives, not votes
Here is my column from 19 December 2013.
The biggest challenge in healthcare is to translate the evidence base into clinical practice that results in good patient experience and better health. This was the core message of Prof Lord Ara Darzi, Professor of Surgery and a previous Junior Minister for Health in England. He was in Dublin recently to be made a member of the Royal Irish Academy and spoke on innovation in heathcare.Prof Darzi has more letters after his name than there are in the alphabet, but his early medical education was spent in Dublin. An Armenian, born in Iran, he came to Ireland aged 17 to study at the RCSI, after which he obtained his MD from Trinity and then spent some years working as a surgeon in the old Meath, Adelaide and Harcourt Street hospitals.
Now Prof Darzi is one of the world’s leading surgeons and experts on global health policy based at the Imperial College London, specialising in the field of minimally invasive and robot-assisted surgery. He gave a wide ranging speech, much broader than innovation, drawing in particular on his experience as a health minister keen to reform.
Health systems are faced with their biggest challenges ever – unrelenting science and technology developments, an epidemic of lifestyle-related diseases, rising costs of care at the same time as many countries, including Ireland, face significant budgetary cutbacks. While we are all living longer, the big challenge now is to add life to those additional years.
The health service we have now was devised when infectious diseases were the primary cause of death, when doctors could learn all there is to know in five or six years of medical education. The rules that established medicine do not apply anymore. While innovation has brought inestimable good to billions of people, health systems as we know them are unsustainable and very different ways of working are required to make them work better. In the words of Prof Darzi, “modern medicine is using primitive technology”.
Prof Darzi’s solutions – improved access, integrated care, utilising IT, a focus on public health, prevention and wellbeing – are not new ideas but his frankness and political nous are refreshing. He made the case for “the politics of saving lives overriding the politics of saving votes”. That is easier said than done, but the fact that someone who had a brief stint as the British Junior Minister for Health was saying it, was useful. Equally encouraging was that the Irish Minister of State with Responsibility for Primary Care, Mr Alex White, was listening.
The solution to saving lives not votes lies in measuring health outcomes and making all health system decisions based on what can be done to improve patient outcomes. When these are the drivers for change, really transformational reform can be achieved.
Lord Darzi spoke about his experience of implementing the stroke care pathway programme in London, which rationalised stroke services from 32 to five centres, a move that was hugely opposed at the time, but is now considered to have saved 100,000 lives. He warned against populist targets such as four-hour waits for ED admission. Most people would prefer to leave an ED within six hours and be guaranteed quality care, rather than be rushed through in four hours with dubious outcomes.
He also cited the example of the patient pathway. A patient with a stomach ache goes to the GP and is referred to the hospital to see a specialist, who in turn refers them to diagnostics for a scan and other tests on another day. The patient is then called back to the specialist, who recommends surgery. The patient returns to the hospital for minor surgery and then returns home. The patient visits the GP for post surgery follow up (she has some ongoing discomfort) and is referred back to the specialist who tells her that everything is perfect. Surely there is a way to design our health systems so that the patient experiences a more seamless journey.
A focus on improved patient pathways and outcomes allows health service leaders and politicians to engage the public and patients and give clear messages on which they can deliver. Defining and measuring quality, and regularly publishing such information drives improvement and rewards excellence.
According to Lord Darzi, central to all this is clinical leaders being the vital voice of change. It is they who can best provide leadership and communicate effectively with citizens and politicians. Much of what he said resonates exactly with the HSE’s clinical programmes. Wouldn’t it be a really innovative Christmas present to the Irish people if our health ministers and leaders focused solely on supporting clinical leaders to deliver improved patient outcomes and prioritised saving lives over saving votes?