Alan Brace Inspires at the HCSA Conference – It’s All About Outcomes

If you had placed a bet before the start of the HCSA conference last week that the best received presentation would come from a Finance Director, you could have got pretty good odds. But Alan Brace, CFO (actually, Director of Finance and Procurement) for the Aneurin Bevan Health Board was genuinely inspiring and fascinating. The Board employs 13,000 people and runs four hospitals, as well as various other services in South Wales, and here are some of his key points.

- The key problem worldwide is that lifestyle and demographics are putting huge pressures on the health systems. It is easy to say that making the NHS more efficient is the answer; in truth we need to do things differently, including addressing the lifestyle issues.

- Brace is a big fan of the work of Michael Porter and Thomas Lee - "The Strategy That Will Save Health Care" for instance.  (I’m off to read that now). When he and his colleagues looked at this, some of the factors identified by Porter and Lee applied in his organisation; for example, delivering care in over-resourced facilities, low utilisations of expensive resource, process variation, lack of cost awareness in clinical teams, and a focus on minimising costs of discrete services rather than optimising the total cost of care cycle.

- So given those comments, Brace is not “anti-efficiency,” but believes we focus too much on cost reduction activities that don’t affect health outcomes, which are the real measures of success. Indeed, “cost reduction without regard to the outcomes achieved is dangerous and self defeating.” A classic example is cutting social care budgets, which then drives greater costs elsewhere in the system (e.g. bed blocking).

- “Value” should be defined as outcomes relative to the costs it encompasses. But how do you measure value in healthcare – because if you can’t measure it, how can you manage it or improve it? There are "technical" outcomes currently measured but they don’t marry up with functional outcomes for patients. A major focus is on compliance with care processes and standards - which are not outcomes!

- We should be sharing options with patients and understanding real outcomes. For example, a high proportion of patients actually later regret having knee surgery done – but the options aren’t really explained to them beforehand. “We're on the wrong treadmill,” Brace says.

- There is a wide range of input costs in health but CFOs (and procurement) just focus on cheaper staff, supplies, equipment - and reducing input costs in isolation can have a negative effect on output.

- We also need more professional development, training etc. for procurement and finance. Brace is addressing that in Wales for Finance, wants to do more in procurement. But procurement professionals have made a massive difference in Wales, and we “shouldn’t beat ourselves up too much” in the procurement community!

So, a 30 minutes packed full of ideas and challenge. His messages about value and health outcomes, as seen by the patient, not just by the clinicians, is an incredibly important and powerful one when we think about where procurement should be focusing. Later this week we’ll look at how that fits with the direction the Department of Health (DH) seems to be taking.

On the meantime, can’t DH make Brace an offer he can’t refuse and get him on board?

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