Ensuring The Survival Of Universal Healthcare - Closing the Gap Between Demand and Resources by Professor Sir Muir Gray

The arrival of the 21^st Century saw the emergence of 3 documents which heralded a paradigm shift to the delivery of high quality care, safety and efficiency. Until 2000 it had been assumed that if people were treated with interventions for which there was strong evidence of cost effectiveness, all would be well. Then the reports rolled off the printing presses, 2 from the National Academy of Medicine, one about how variable the quality of care was, with many services completely unaware that they were providing care that was inefficient, ineffective and unsafe, the latter factor being reinforced by the Academy’s second report titled To Err Is Human. The subject of patient safety which had previously only been highlighted with respect to errors that went to court, but which the Report of the Chief Medical Officer Sir Liam Donaldson called the Organisation with a Memory…learning from adverse events emphasised that safety failures and errors were ubiquitous and unrecognised. This led to the quality and safety paradigm, with management developing one aspect of quality, namely efficiency:

Continual improvement in quality, safety and efficiency of services to patients is essential, but not sufficient, and we then realised that when spend and activity are related to the all the people in need in the population and not just to the patients treated, three major problems are revealed:

• Unwarranted variation in spend and activity, that is variation that cannot be explained by variation in need and this reveals two other problems,
• Underuse of high value interventions and inequity, and
• Overuse and waste, where waste is not just inefficiency but also the use of resources which would give more value if used for another intervention for people in that subgroup of the population, or reallocated to another subgroup of the population.

The new paradigm of value based healthcare has been developed to tackle these 3 problems by enabling health services, through professional and organisational development to a new way of working with five themes:

1. Define population segments with a common need such as people with respiratory disease and allocate resources optimally
2. Design the system for each population sub-group for example for people with COPD
3. Ensure each individual makes decisions to optimise personal value
4. Deliver value for the population and all the individuals in need equitably through networks
5. Create the culture of stewardship, with a governance process that promotes collective responsibility with clinicians responsible for optimising the use of the resources their population segment’s budget and clinical time

We need a new paradigm - Value Based Healthcare with a Culture of Stewardship:

Our mission in the Oxford Value and Stewardship Programme is to accelerate this paradigm shift. OVSP has created a series of short online training courses and learning modules so that you can increase confidence for understanding value based healthcare, they were designed in response to increasing demand for accessible learning modules when The NHS is facing unprecedented pressure from increasing need and demand, a substantial backlog of people waiting for care, decreasing budgets and a stressed workforce.

Relevant to any stage of a career, established professionals may look to complete the course as evidence of CPD and for their portfolios.

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