Changing Healthcare: the case studies
Case study 1: NICE
The National Institute for Health and Care Excellence (NICE) was set up in 1999. It has two main purposes: setting professional standards through guidelines for healthcare professionals, and assessing the cost effectiveness of new drug treatments to determine whether they should be used. NICE was established in law in the Health and Social Care Act 2012, as a non-departmental public body (NDPB).
Providing guidelines on a range of areas covering health and social care and public health, there is significant evidence showing that NICE has had a positive impact on improvements in healthcare. NICE guidance is widely regarded as authoritative with, in some cases, legal status.
What is about the design of NICE that has made it successful? We will consider factors like organisational design, the use of evidence and breadth of engagement to focus learning for those working in the system now.
Case study 2: Increasing day surgery
In 1990 the Audit Commission published its first NHS value for money report which identified several interventions that clinical opinion suggested could be carried out as day cases. Following this review the Department of Health set up a task force on day surgery and in 2000 set a target that 75% of all elective surgery should be performed as day case procedures.
This target, combined with support from the Royal College of Surgeons, resulted in a significant increase in day case surgery – not only offering an estimated 1.3 million more people the chance to have elective surgery, but also resulting in an estimated £2 billion in savings for the NHS.
How did the healthcare system deliver the transition to day surgery? We will consider factors such as the role of clinical leadership, the impact of new technology and the way learning was shared across the system to inform learning for those working in healthcare now.
Case study 3: The reduction in healthcare associated infections (HCAIs)
In the early 2000s there was widespread media coverage of people developing infections (including MRSA and C difficile) in hospitals. The government introduced a series of initiatives, including mandatory reporting of infection rates, legal requirements for healthcare providers to provide protection against HCAIs, funding a national ‘cleanyourhands’ campaign and the mandating of the creation of a Director of infection prevention and control.
Following the introduction of this bundle of initiatives, rates of HCAIs fell significantly and, in many cases, the rate at which they fell exceeded targets.
Why was the NHS so successful in achieving the reduction in infection? We will consider issues such as the roles of national leadership, targets and accountabilities. How did these factors combine and what learning can we draw from this approach for other challenges health and care organisations are currently facing?
Case study 4: Implementing non-medical prescribing
Since 1994, nurses in England and Wales have been legally able to prescribe, and following the innovation with nurse prescribing other professional groups followed. This approach to prescribing is in contrast to much of Europe and North America, where in some countries only nurses and doctors may prescribe medication, and in others only doctors can.
The evidence around this innovation shows that people are happier with their experience as a result of non-medical prescribing – both with their access to care and the quality of the appointments to discuss their medication.
What drove this pioneering change enabling the healthcare system to embrace other health professionals prescribing? We will consider issues such as how successive changes contributed to the development of non-medical prescribing, and the role of patient satisfaction in driving this forward.