Tuesday, July 8, 2008

Health Care Policy Questions in UK and Mediracer

I got this information through Veijo Lesonen with a more specific reference to this PDF and page 7 that I'll be quoting below the NHS Policy Exchange Information

Health: "The traditional model of the NHS has been characterised by a highly centralised management structure; successive governments have failed to delegate responsibility to a local level. Policy Exchange believe that Healthcare providers need to become embedded in their local communities and that strong public involvement in decisions about health and social care priorities is critical. Our research, whether into improving healthcare innovation or the role of the private sector, is from patients’ perspectives."
The quote on page 7 starts here.

The artificial barrier between health and social care is a further division. Social care is not part of the NHS system; yet caring for those with long-term conditions requires effective communication and collaboration between different professional teams that span this divide. This often proves difficult.

Cultural silos

“There’s no question that one of the barriers to innovative medicine in the UK is the medical profession. And they’re very, very conservative … I would argue, exceptionally so, to the disadvantage and detriment of their patients.”

Managers naturally rely on the advice and ideas of senior clinicians, because they lack clinical
training, and the culture of the NHS old guard is often characterised as conservative, parochial, and territorial. Clinicians are justifiably protective of their autonomy over clinical matters, but in some circumstances this can be used to resist uncomfortable changes, such as innovations that disrupt their professions, or the push for greater transparency through clinical audit. It is very difficult for managers to lead service change in the health service, and thus to respond to pressures from commissioners and the centre to improve quality.

Case Study 1: Mediracer diagnostic device (link to pdf)

Carpal tunnel syndrome (CTS) causes pain and tingling in the hands and is 3-5% prevalent in the
adult population. Currently, diagnosis requires referral to a neurophysiologist, which can add up to six months to the treatment pathway. A new hand held device for diagnosing CTS has now been developed, which can be used in outpatient and primary care settings. The technology has been taken up by a team in Leicester, who created a one-stop clinic for diagnosis and treatment of CTS.

In less than two years they had secured over 90% of referrals from the Strategic Health Authority (SHA) saving the NHS £1.7 million and earning an innovation award from Medical Futures. Since publicising their work, the team has encountered significant opposition from third parties. For example, neurophysiologists argue that the test is not as accurate as the gold standard (the new test is sensitive (94%) and specific (98%) compared to a conventional EMG test performed by a specialist).

Instead of looking for ways to incorporate the greatly improved pathway and make sure problem cases are referred for further tests, there has been a resistance to dialogue.

This technology could greatly reduce waiting times and Medical Futures estimates the potential national savings to be over £72 million.

There are also divisions between different professional groups, who can have diverging interests. Tightly-knit professional networks can operate as channels for new ideas to spread.

But they also serve to create cultural divisions between professions, reducing the spread of innovations that impact on multiple clinical areas and require close inter-professional collaboration.

The simple rule for adoption in the NHS is; the more parties that are involved, the less likely it is to happen.

Helge: It looks like the climate for innovation adoption isn't much different in many other countries. Medical innovations are suffering while the field is limited to very large organisations with deep pockets. Mediracer has stubbornly continued to fight against a likewise stubborn opposition. But what if we would have a more adaptive environment? What could it mean for patients? And how about health care costs?

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