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Lord Andrew Lansley CBE: Value-Based Healthcare – WES 2019

Lord Andrew Lansley CBE, former Secretary of State for Health gave a talk which focused on what is “important to be achieved to deliver better value health care”. During his time in the coalition government, he characterised the healthcare service “he had inherited” as being a service which “had grown and was performing well, but where costs were rising and productivity was falling”. He explained how that needed to change, and how he set about trying to do just that.

The NHS is almost unique in its structure of providing “universal access to healthcare without intermediary health insurance”. However in the past, the NHS has faced problems: Lord Lansley spoke about how “when providers of healthcare can vary quality and price, they tended to prejudice quality in order to get better margin on price”. This meant that the quality of healthcare was compromised. He explained that this can be resolved by giving practitioners the position of responsibility both for the “care of their patients, but also for the budget”. This leads to a stronger, more efficient healthcare system, where “patients and practitioners make decisions together” as part of stronger community – and the responsibility was shifted into the local sphere.

“providers of care should be held to account for the value of care they provide” – Lord Lansley CBE

Tied to this is the idea that “providers of care should be held to account for the value of care they provide”. Value, in essence, is the delivery of “better outcomes for controlled cost”. As well as reducing costs long-term, delivering value also involves reducing the disparity between the quality of care received in different areas of the UK. Tackling these issues was one of Lord Lansley’s main aims during his time as Health Secretary – and he described how he introduced a structure of ‘an outcome framework against which healthcare should be measured’.

“the utter fallacy of treating a target as though it were an outcome” – Lord Lansley CBE

The reason he introduced this framework was in reaction to the targets-based measurements previously used to evaluate hospital performance, through targets like “every patient seen in under four hours”. He explained “the utter fallacy of treating a target as though it were an outcome” – as it makes hospitals likely to want to see fewer patients to meet the target. Achieving these targets doesn’t account for the failings of these hospitals, like the number of patients who visit and leave without being seen at all. By basing the system around short-term targets, rather than evaluating the provision of care based on the long-term outcomes of treatment, the system was not providing the best value healthcare for patients. Lord Lansley argued for a healthcare system that would put the value back into the secondary outcomes of treatment – where success should be measured upon long-term consequences and real results for patients, rather than short-term targets that don’t reflect the hospital’s actual impact.

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