Jennifer Dixon, chief executive of the Health Foundation, speaking at the second Sciana meeting

Sciana leaders: towards stewardship of their national systems

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Chief executive of the Health Foundation discusses role of Sciana and sharing insights to accelerate effective change

I’ve worked in the health sector for over 30 years, first as a doctor then analysing and helping to steer the UK National Health Service forwards and improve population health. I’m struck by the number of opportunities there have been to discuss international developments on these issues with colleagues in the USA over others from elsewhere in the world, particularly in Europe. The experience is not unusual amongst others I talk to in the UK NHS or the research and policy community. This is despite the obvious fact that there is far more agreement on the role of the state to support society and the values that underpin health care systems, in Europe compared to the US.

Part of this state of affairs is because of a shared language and the sheer volume of high quality health services research and analysis which is carried out in the US on subjects very relevant to the population health and improving the NHS, such as public health interventions, and measuring and improving the quality of care through various means. Yet a combination of increasing research of this type across Europe, plus the fact that many international meetings are conducted entirely in English, really opens up far more opportunities now for effective exchange and joint work between people in the UK and other countries in Europe. Personally, I benefitted from this hugely in my career with respect to the US, stemming from a Harkness fellowship in New York. Had there been a similar opportunity in Europe, I would have taken it.  

This was the impetus behind the setting up of Sciana: The Health Leaders Network. Part of the offer of the programme is to help leaders from the UK, Germany, and Switzerland understand how each others’ country is trying to improve health more widely, as well as understand each other’s health care system, and in doing so gain fresh insights about their own. Because of our shared commitment to providing universal coverage to all our populations, and reducing inequalities in health, this understanding is crucial.

What’s been apparent to me so far in our meetings is how many of the UK Sciana leaders have had to think about ‘national system level’ issues, as well as their own local work, compared to colleagues in Germany and Switzerland. As far as health care is concerned, the NHS is a tax-funded and centralised system, the scope for political direction is high, and because health care is clearly hot news and national politicians so clearly accountable for it, the NHS is never far from the headlines.

Over the years government policy has had huge and obvious impact on the way the NHS is structured, organised and managed, and all of the UK group have had to implement them one way or another. Notable policies have included introducing patient choice and competition among NHS providers, encouraging the NHS to buy care from non-NHS providers, introducing stronger national regulation of quality of care, requiring practices and hospitals and other NHS providers to publicly report outcome data to allow comparisons, introducing financial incentives including pay for performance, and more latterly encouraging capitation based integrated care. These issues and the research underpinning them is high profile.

In fact, it is hard to find a time when the NHS, and some aspects of population health, have been higher profile than now. As we heard at the last Sciana network meeting in November in Salzburg, the NHS is receiving the most sustained financial squeeze in its history, with 1% real terms growth on average over the decade 2010-2020 rather than the long run average of nearly 4%. This combined with cuts to social care for older people, and this winter flu had led to a spike in pressure on the NHS, resulting in overfull hospitals, longer waits for emergency care and deferred elective care. While this is painful, as patients, clinical staff, and media headlines in the last eight weeks testify, it is also triggering rapid innovation which is rich learning for Germany and Switzerland. Both countries are in the luxurious position of having well-funded health care systems. But with the increasing age and frailty of the population, the fact that health care costs are comfortably outstripping GDP growth and taking a larger share of government funding, the day will surely come when pressures for change will mount. The amount of experimentation going on in the UK backed up by evaluation and analysis, and testimony of experienced leaders on what accelerates effective change, is surely of huge value.

The Sciana network is one important step to share this, not in a formal international meeting, but informally between friends and colleagues now and in the future.

Jennifer Dixon, Chief Executive, The Health Foundation

23.01.2018