What drives successful (and sustainable) system change? This won't stop being a relevant and compelling question. We should perhaps acknowledge though that, at least in terms of healthcare, we have a prevailing orthodoxy - that top down, mandated and performance managed changed is the default method.
The healthcare system has been trained to receive and act upon the annual operating plan. That plan describes the what, the how, the 'by when', and the 'how much'.
We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else?
We see it as our duty to ensure as many patients as possible get access to world-class treatments and round-the-clock care – both of which are more likely in reconfigured acute stroke services.
Evidence of the benefits of stroke service reconfiguration is overwhelming. Where it has already happened, for example in London and Greater Manchester, reconfiguration is saving hundreds of lives a year, and patients are reporting positive experiences of care in hyper-acute stroke units (HASUs).
Stroke is not the same as cancer. Maternity services are not the same as psychological therapies. But is there learning to be gained from thinking about how system change happening in one clinical area could be transferred to others?
That was the premise behind our event series, in partnership with UCL, and funded by the National Institute for Health Research, which explored how the learning from stroke reconfiguration in London and Greater Manchester could support successful system change across the NHS.
I’m delighted to have been part of the recent learning from stroke webinars, where we had wide-ranging discussions of key aspects of major system change.
In our first webinar, Naomi Fulop, Steve Morris, and Ruth Boaden presented our NIHR research on centralisation of hospital stroke services in London and Greater Manchester, reflecting on how changes were led and put into action, and their impact on patient outcomes, delivery of evidence-based care, cost-effectiveness, and patient experience.
In our second webinar we turned to international perspectives on major system change: Allan Best gave insights on key principles and approaches to carry out such changes, and Kristian Taageby Nielsen shared the case of current work to reconfigure hospital care across the whole of Denmark.
I'm excited about this month's upcoming events to discuss the lessons of the changes to stroke services in London and Greater Manchester.
The events will draw on the findings of the study led by Professor Naomi Fulop of UCL, which brought together a team of researchers, clinicians and service users from London and Manchester to examine the effectiveness of stroke reconfiguration. I am delighted to have been a member of this team.
But why are we talking about stroke reconfiguration in London and Greater Manchester? And why are we talking about it right now? We believe that, by using a mixed method approach to study a number of cases of major system change in stroke services, our research has identified several lessons for people who want to carry out changes of this kind in other settings.