10 Insights for Sustainable Healthcare in Australia from Sir Robert Naylor

Sir Robert Naylor and Avi

At a recent conference hosted by the Health Services Innovation group in Tasmania, I had the privilege of engaging with a few leading CEOs and researchers in healthcare. Whilst there were many highlights, Sir Robert Naylor, the CEO of  University College London Hospitals (UCLH) was outstanding in his insights.

UCLH has been ranked the 4th highest performing NHS Trust in the UK and a large part of that is due to its clinical and executive management approaches.

A few key points that he made:

1.  Payors in the UK i.e. government funding authorities are increasingly wanting to pay for value, rather than activity. This sentiment has been echoed in Australia as we are placing more thought on how Medicare can move toward a model of payment for outcomes, rather than activities.

2.  Providers need to focus on ‘transformation’ rather than ‘translation’. Sir Robert suggested that there is a need to form integrated systems along pathways; in order to this incremental changes is no longer good enough and patient pathways have to be viewed and changed as a whole.

3.  It is imperative to engage patients as active partners in their care. “Doctors need to change from being God to Guide”. We need to change the current archetypal image so patients have more ability to take responsibility for their care.

4.  Integration would be improve outcomes and reduce costs. The word “integration” is used often, but the word means different things to different stakeholders

5.  Sustainability is the “nirvana” that we are looking to achieve. In the UK, the healthcare system has 8% reduction in funding next year due to a “Cost improvement program”, while in Australia, stakeholders are complaining about 4% growth.

6.  Consumers and the public trust doctors, hence Sir Robert feels that we have to get the clinicians to communicate with the community. People want a good relationship with their GP, and GPs that understand patient’s concerns.

7.  He also encourages more clinical leadership in executive teams and encourages them to train in business and management skills. His Medical Directors manage the money, the people and the quality or care.

8.   Sir Robert observed that Australia is 5 years behind the UK in terms of the performance data currently published, which is not sufficiently meaningful for real change. Publishing league tables is good for improving transparency and performance; at UCLH they publish mortality rates down to doctor level. The 2013 Francis Report on failings in Mid-Staffordshire NHS Trust was a largely due to a lack of transparency – this is why league tables are very useful.

9.   The top priorities at UCLH are Patient Quality which includes:

·         Patient outcomes (is it going to make me better),

·         Patient Safety (is it safe for me),

·         Patient Experience (compliments/complaints)


These top priorities are put up on whiteboards on each ward, with top metrics updated daily e.g.. staff levels, infections rates. Each of his 9000 staff need to have these translated in a way that is meaningful to them, including janitorial staff.

10.  In terms of current thinking on innovation in the UK, a 5 year forward review by Simon Stevens suggested

  • Radical upgrade in prevention and public health
  • Break down barriers between GPs and public hospitals
  • New models of integrated care (Dalton Review)
  • Re-design emergency and urgent care

Sir Robert recommends tertiary health centers should focus only in a couple of areas of expertise where possible as it improves outcomes e.g. Cancer and Neurosciences. This is to establish critical mass, and involved UCLH giving up cardiac patients to other centres, but will dramatically improve mortality rates and build capability. He admires the Dutch system where they selected only 8 hospitals to treat complex chronic disease patients. Centralising services like stroke services has reduced mortality by 50%.