Last week saw OBH’s 9th birthday. I often take this point each year to reflect on where we are on OBH’s original mission; to support health and care systems in better measuring and improving outcomes. A mission that has evolved significantly over the last 9 years.
When we founded OBH, the role of health and care was quite different. Long before ‘Integrated Care Systems’ were a thing, providers were still very much encouraged to compete on activity, especially in urban areas with multiple hospitals. Commissioner and provider dynamics remained formal and unintegrated. Measurement of success and payment meant a focus on ‘performance’ by individual care settings. This largely involved measuring care activities, processes and outputs. For example, counting volumes of procedures, and ensuring routine quality processes and safety standards were met.
Usually these were targets set to largely measure compliance with annual, mostly volume-based contracts. At that time very few areas of the country were measuring population-level ‘outcomes’ – measures of what really matters to people receiving care. Those areas that were interested sometimes struggled to measure outcomes across organisational provider boundaries – hindered by data silos and payment obstacles. Some of these obstacles remain to this day.
During this early period OBH spent a lot of time ‘mythbusting’ (https://outcomesbasedhealthcare.com/resources/). Although that was 2014, the content still seems relevant today. The conversation was all about making the case for ‘why’ outcomes mattered, alongside the essential work of co-defining outcomes for groups of people with similar sets of health needs. Looking beyond care for just single conditions, and seeing the person beyond the disease. Fortunately, that argument seems largely over by this point, and systems are now focussing much more on the ‘how’ of outcomes rather than the ‘why’. Finally many policy enablers seem to also be moving in the right direction. It feels like there is now serious effort being put into sorting the remaining obstacles out.
Our work on outcomes has evolved significantly alongside this. We decided we needed to help get some of the plumbing right. For person-centred outcomes, spanning care providers, you simply can’t measure outcomes properly if you don’t have decent population condition registers. So the last few years have been focused on building the evidence base and code base for supporting systems to create longitudinal datasets and condition registers. Given that the whole idea and framework is well established, our role is increasingly to stand aside and coach or enable, rather than to ‘do’ ourselves. The plan from the beginning has always been to accelerate the growth of outcomes based healthcare in the NHS, even if that means taking some tough decisions. It has been challenging to decide when and how to sustainably share intellectual property with our NHS colleagues, which we have spent years and significant investment to develop. For OBH it’s never been about whether to share our IP. It is always about when and how to do that sustainably, and with maximum impact. Above all that needs a measured approach, otherwise our experience has been that it just doesn’t work. We used to provide a lot of the output analysis ourselves. But we are increasingly supporting development and clinical curation of large volumes of raw data into high quality longitudinal input data for analysis and research, alongside coaching of NHS analysts around the challenges of using that data. I’m genuinely excited about where these increasingly open ways of working take us next.
There have been some big analytical milestones for us over the last couple of years – particularly during the pandemic. The launch of the national ‘Bridges to Health’ segmentation dataset, working closely with our colleagues on the Population and Person Insight Team in NHS England and local systems, has provided a glimpse of what is possible in person-centred health analytics. Building on this in early 2020, the first national objective measure of population-level HEALTHSPAN was published, covering over 60 million people. It will be vital to track this outcome longitudinally over the course of the pandemic recovery, to make sure of a fair and equal recovery. This work is all underpinned by what I believe to be one of the most advanced health data and analytics environments anywhere in the world.
So, on our mission to help the NHS implement outcomes based healthcare, it does at least feel like the end of the beginning, if not the beginning of the end. Does that mean it is plain sailing on outcomes measurement for the NHS. Sadly not. Recent headlines remind us only too starkly what happens when outcomes are not openly published, reviewed and acted upon. Are there still challenges? Of course. We’re still far too focussed on only measuring outcomes once someone is already experiencing ill health, when someone is already past the best opportunity to make a real difference. That is necessary, but insufficient. If we’re really serious about a sustainable NHS, free at the point of care, we need to move far upstream and get serious about proactive prevention (even if that ultimately means passing some NHS funding into other public services, such as education and social care). But a senior leader in our profession recently said that in data and analytics it feels like the NHS is now on the cusp of something really special. I think they are right.
In personal highlights, alongside a number of publications for OBH this year, we were thrilled to be awarded a Queen’s Award for Innovation in 2021 for our work on data analytics and the first objective measurement of HEALTHSPAN in particular. This marks the culmination of many years of hard work by talented and dedicated colleagues in OBH. Many of whom have been with us since the beginning, alongside newer but equally brilliant and committed team members. But most of all we have been lucky enough to work alongside some genuinely brilliant people inside the NHS. Thank you.