The 30-year itch – The evolving story of Connect Health and how my approach to MSK health has changed

Two-part blog by Prof Andrew Walton, Executive Chair, Connect Health, reflecting on challenges and achievements over the last 30 years, in celebration of the organisation’s 30th anniversary year.

20 April 2019

Two-part blog by Prof Andrew Walton, Executive Chair, Connect Health, reflecting on challenges and achievements over the last 30 years, in celebration of the organisation’s 30th anniversary year.

It all started 30 years ago, when I was an enthusiastic, if not somewhat naïve, a physiotherapist working in the NHS. Unfortunately, I soon became frustrated at the waste, complacency and clinical variation experienced and unable to sufficiently influence or drive change, it wasn’t long before I was seeking new ways of trying to improve the system and culture, resulting in setting up Connect Health in 1989.

A further change came in 1993 when I was approached by a fundholding GP in South Shields, to seek an innovative solution to what remains a common, systemic problem; sub-optimal use of rehabilitation and long waits for physiotherapy.

Traditional services are often highly medicalised and interventional using excessive diagnostics, treatments without clear evidence, but with the high cost and little outcome data. Whilst there is still a high public expectation for diagnostics and passive interventions, I was keen to build on evidence that active rehabilitation improves sustained benefits and patients re-presenting to their GP with chronic diseases and pain.

Corporates see the benefit of reduced absence

In the same year, a local factory that made paints (International Paints) approached us to deliver our first occupational health physio service because we were successfully treating a minority of their staff privately, who’s absence from work was much less than other staff treated elsewhere. The occupational health nurse recognised this and wanted to work with us so that all her staff could benefit.

So the business progressed and found its niche in three markets – private practice, occupational health and the NHS and a period of steady growth ensued, with year on year improvements in quality.

This was all coupled with a busy family life with three children born 1993-1996.

Investment in non-clinical management vital for growth

In 2013, the company had a change in strategic direction, to focus exclusively on the NHS and corporate contracts. I realised that whilst we knew lots about what good MSK services looked like from a clinical point of view, the infrastructure that had previously served us well, would not be fit for purpose in a faster-paced and larger organisation.

The board and senior management team were strengthened and so began our investment in non-clinical management, who in turn brought new ideas, ways of working and technology solutions. Ironically, whilst the NHS looked to reduce the number of managers to minimise costs, over the last 6 years we have increased the investment in non-clinical areas.

Innovative data warehouse has been fundamental to success

Whilst for 24 years, we were making marginal improvements every year, even though we recruited the best clinicians and embarked on the best in service development, it was the investment in our data warehouse that has made an enormously positive impact.

Enabling a light to be shone on performance both in terms of inputs and outputs, clinicians responded positively to having real-time visibility of performance and adapted their practice to more consistently improve outcomes. It is commonplace for clinicians to find that up to 30% of what they have been doing is of low or no clinical value. It is extremely rewarding to then see a change in practice, resultant patient outcomes and a reinvigoration of enthusiasm.

Realising measurable improvements across our three stakeholders

Our efforts have resulted in measurable improvements in clinical quality and operational efficiency.

  • Firstly, for patients – Connect’s patient-reported outcome measures consistently exceed the previously published mean change for physiotherapy of 0.16. For example, in Nottingham, our EQ5D score is 0.22. To put this into perspective, if a patient with severe knee osteoarthritis has a successful knee replacement, the score would be between 0.13 and 0.35, so our outcomes are meaningful.
  • Secondly, for tax payers – Our innovative model of care uses performance data to achieve 30% service efficiency across our newly mobilised contracts, reducing NHS patients’ average waiting times from 10-12 weeks to just 48 hours for the first contact with a physiotherapist, enabling better outcomes and relieving increasing pressures on primary and secondary care.
  • Thirdly, for our colleagues – We have just run our annual people survey and I’m really proud to hear that 80% of our staff think it’s not just a good place to work, but it’s a great place to work. That’s a 31% rise over 3 years. Business growth creates opportunities for individuals to develop; there is great pleasure in seeing people take on new roles, make a success of them and grow in self-confidence as a result.

The past has laid a firm foundation and the future is exciting

Looking back, as a clinician, for me, it is wonderful to see such improvements and it’s fascinating that the investment in non-clinical resources is deriving the most benefit to clinicians and patients.

I’m happy to say that we’ve reached a high level of sophistication in terms of the delivery of MSK health and we are looking to diversify based on the investment in our infrastructure and the value we can add to others in partnership.

The improvements in the visibility of outcomes inevitably raise more and more questions. Because we have 25+ services, all of which are slightly different, and an improving understanding of the relationship between inputs and outputs then we have an opportunity for further improvement. So, my instinct is, that whilst we have made good progress in the last 30 years, we will change much more over the next 10 years.

See my second blog on the next 10 years, coming soon ….

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