The Cumberland Initiative

Source: National Health Executive Mar/Apr 2013

The Cumberland Initiative is an effort by a community of academics, clinicians and health technologists to transform the cost and quality of NHS care through better use of systems thinking, simulation and modelling, and through more effective partnerships between the NHS and industry. NHE discusses this vision with one of its founders, Professor Terry Young, professor of healthcare systems at Brunel University.

Nearly three years ago, in summer 2010, a group of academics specialising in simulation, modelling, and systems thinking for healthcare from more than a dozen universities met at Cumberland Lodge on Windsor Great Park.

Their discussion resulted in the founding of The Cumberland Initiative, which has led to many more meetings and the group has expanded, now including clinicians, NHS managers and industry leaders as well as the original academics.

In early May, the network is launching its National Centre with an event at IQ Winnersh, near Reading (see panel, far right), allowing attendees to test out, through models and simulation, new ways to tackle healthcare problems, and to explore ways of remodelling urgent and unscheduled care using the lessons from systems thinking, with speakers from hospitals, universities, NHS bodies, ambulance services, health businesses and the Welsh Government.

A step-change in health delivery

Terry Young, professor of healthcare systems at Brunel University, helped found the Cumberland Initiative. He told us: “The vision we have is of a step-change in delivery in healthcare through better use of systems thinking and the tools that go with it.

“We also want to see a real stimulus to the economy through companies developing products that will work for the NHS but also spin out into other sectors – the ‘health and wealth’ agenda.

“We’re not about transferring money from public sources to private sources – that’s not what we’re trying to do.

“We’re trying to find products that solve problems in innovative ways for health that can then be spun out to other sectors.”

He gave the example of the ways technologies developed by and for the military since the second world war have since had vast impact in other sectors and for the consumer, from home computers to sat navs and mobile phones. “The same thing could happen in healthcare,” he said.

The time is now

In early April, Cumberland Initiative participants are having their 11th ‘overnight workshop’, and it also had a stand at the Healthcare Innovation Expo.

We asked Professor Young about the extent to which the wider NHS is embracing the kinds of thinking his initiative represents and about the pace of change needed to address the challenge.

He said: “There’s a general move in this direction and we’re getting a certain amount of support. The trouble is, there’s a catch-22; if nobody else is doing it, is this the right thing to be doing? If everybody else is doing it, why should we?

“But we think we’re at just the right stage, where a number of people are looking at this. Some of the systems thinking ideas have been pushed for quite a long time, but they really haven’t gotten going properly. There’s a recognised problem that healthcare doesn’t naturally pick up these methods and use them. I’m not completely sure why that is.

“We want to get together all the best academics in healthcare simulation, management science and operational research in the country, aggregate with the best from industry, create a national support centre, and try to create a kind of focal point.

“We are starting to attract people from the clinical community, particularly people who are stepping up for the first time to serious management responsibility. They are very interested in what we’re up to.”

A national centre

That national centre – a permanent home – is the next big goal, and the initiative has longterm ambitions for a ‘National Institute for (Health) System and Service Excellence’, or NISSE.

Since the group is aimed not just at healthcare problems but at economic growth too, Prof Young said it may be able to get some help from organisations like the Technology Strategy Board.

“The trouble with the health and wealth argument is that it falls between about four different stools [in government]; it’s actually quite diffi cult to bring people together around this theme in a big and significant way.”

He noted a big disconnect between the people who are going to use something as part of service delivery, and the people who are going to make it, as having been a problem in British industry and industrial policy for decades.

“But the belief behind the Cumberland Initiative is that if you can get the communities together, make them play together and come up with ideas, they will make it work themselves. I’d certainly value any help we can get in terms of co-ordinated government funding.”

Funding sources

He suggested that getting the idea fully off the ground could take around £3m. “My guess is that the fi rst tranche of funding will probably have to be public funding,” he told us, “but I think ultimately we’ll be able to get a lot of private funding because what industry lacks is a really good way to get next to healthcare – to get access to clinicians who are changing things and want to change things.

“They want to speak to clinicians and fi nd out what they really want to do, and then start to offer them solutions that they want, rather than ones someone designed for a different healthcare system with a different way of doing things with a different clinical language.

“We’ve got a tremendous opportunity here.

“If people could bring products to market confi dent that they’d be taken up, knowing how they’d be used – and if people designing services knew that certain technologies were going to become available, particularly around information and knowledge, you could get some kind of synchronisation between the cycles of service improvement and the cycles of technology innovation.”

Sir Richard Thompson’s ‘Cumberland Challenge’

Last year, The Cumberland Initiative ramped up its engagement with Royal College of Physicians, which calls it “an interesting and innovative approach to the overwhelming problems of improving effi ciency while reducing costs in healthcare”.

Its president, Sir Richard Thompson, then set three challenges to be addressed:

1. How can we quantify the value of knowing ahead of time what work is coming up?
2. Can clinical pathways ever be streamlined to a point where an engineering approach would make sense?
3. How much of the ‘waste’ in the healthcare system is recoverable by better knowledge of flows and process management?

“We are keen to work with the Cumberland Initiative to put the answers to these questions onto an evidence-based footing to the benefi t of all parties,” Sir Richard said then.

Prof Young sees the event in May as a way of answering the questions set by these challenges. He said: “The questions certainly span dialogue and Sir Richard continues to stay in touch with us. Those questions have been effective because they’ve stirred up a debate. Some people love them, some people disagree with them completely, but I’m really grateful for the engagement.”

He is keen for NHE readers to join the growing list of clinicians and managers involved in The Cumberland Initiative and receiving its updates (see below for contact details). He said: “We’ve had some fabulous discussions, particularly where people have been getting involved.

“At the grassroots level, have we got the scale and capacity we’d like? Not yet. But shared ideas and passion? Plenty!”

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