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A new way of thinking: designing more integrated care with patients

Change in the NHS can be slow. Here Dr Binita Kane explains how clinicians, patients and strong strategic leadership are coming together to make a difference.

It seems like a fairly obvious thing to do now but during my training to become a specialist I had never been encouraged to have patient representatives embedded at the heart of a project to redesign a hospital service.

What changed? Between 2015 and 2017 I was fortunate enough to lead the Manchester Respiratory Future Hospital development site, supported by the Royal College of Physicians. It was a great experience and fundamentally changed my thinking about systems leadership, not just by involving patients but also using data to drive quality improvement.

It wasn’t until I started talking to patients (really talking to them) and sitting around a table with ordinary folk, that I started to understand what is important to people living with a long-term condition – and it was different to my own perceptions.

It dawned on me that our services had been set up around the needs of organisations, or where a building happened to be placed, rather than around the needs of patients.

There were fundamental questions about how we measure outcomes. Success seemed to be based on satisfying arbitrary targets, above which was deemed ‘green’ and below which was ‘red’, but what did this actually mean? Was measuring these things leading to any meaningful change or improvement and how did these relate to what was important to patients?

Perhaps one of the most positive changes I have seen in the last 2 years is that we are now working together with patients, commissioners, public health, primary care and Right Care to develop intelligent KPIs (key performance indicators). These are designed to drive improvement in the health of the population. We are still in the early stages of this work and it will remain to be seen how this affects patient outcomes.

Supported by Health Innovation Manchester, some of the concepts born out of the Future Hospital pilot are being scaled up across Greater Manchester. We are attempting to overcome the NHS legacy that it takes an average of 17 years for a new innovation to be embedded and trying to drive ourselves (at least some way) out of the technology black hole.

While the NHS remains so painfully hierarchical and progress can be slow, bottom-up change is making a difference, driven by clinicians and patients but with strong strategic leadership. I feel very privileged to be part of this change.