Dame-Barbara-Hakin-PHM-Reflections-Article

Population Health Management:

My reflections on its past and hopes for its future

By Dame Barbara Hakin, July 2023

Introducing our new PHM Perspectives blog series, former Deputy Chief Executive of NHS England and Optum strategic adviser Dame Barbara Hakin reflects on her early experiences of population health management and what it has taught her about leadership and change.

It has been a big couple of weeks for our health service. From tributes at Glastonbury to tea parties around the country, the way we’ve commemorated the NHS’s 75th anniversary shows the deep admiration people have for our health service and the special place it holds in our national story.

Yet these wonderful celebrations can’t mask the monumental task ahead for the service – both in terms of managing the here-and-now challenges of waiting times and soaring demand as well as the long-term responsibility to reform and reshape our health and care system for the future.

In fact, looking back over the fifty or so years I’ve spent in the NHS, I’m not sure things have ever been as tough as they are now. Yet the challenges we face are familiar to every developed nation: namely, how to support an ageing population with increasingly complex needs and an ever-increasing array of treatments, within finite resources.

Whichever plan you look at, in this country or beyond, there are two fundamental things that are heralded as key to a solution. The first is prevention whether primary through a range of public health interventions or secondary – that is, treating people earlier and more proactively in the course of a disease. And the second is innovation, particularly so when it is enabled by technology and supported by data and analytics as the “guiding hand” helping us make the right decisions.

Of all the recent advances in data analytics, population health management (PHM) is probably one of the oldest and most advanced. At its best, PHM can help us shine a light on what may be hidden, hear the voices that may otherwise be missed, and allow our services to reach those who need them most. And that’s hugely important when we need to ensure that every ounce of effort makes the biggest difference for our communities.

Lessons from the past

But, of course, the application of PHM principles is not particularly new. In the early 1990s, I was involved in the introduction of community matrons within primary care. Back then, we didn't have the huge range of data or the analytics capabilities we have now, but we were able to identify those patients for whom you could do something more to prevent them from a hospital admission or some other episodes of ill health. It was an early precursor to the more sophisticated approaches available today, but it taught me a couple of things that feel just as relevant.

The first critical lesson I learned was that your success will always be determined by the strength of the partnerships and collaboration you build. It was noticeable, for instance, that the impact generated by our community matrons shifted up a gear when we asked local practices to select and employ them rather having them recruited by the Primary Care Trust that I was leading at the time. So change management is a vital part of getting new technologies and approaches adopted.

We talk a lot about ownership, empowerment, agency and choice when it comes to supporting our patients, yet we don’t always apply them consistently to our own people in terms of how they approach their roles. The raw insights and intelligence we can extract from our linked data will only ever be as strong as the conversations, coalitions and collaborative action they help to stimulate.

The second important lesson I took is that less is more. We were able to make some significant inroads with very limited technological firepower in the 1990s. Clearly having the infrastructure to deliver more advanced analytics is obviously desirable, but you can start with relatively modest means.

In other words, PHM doesn’t have to be complicated or all-encompassing. The value lies in identifying a specific cohort of patients you want to work with and then brokering conversations about what a ‘gold standard’ approach to care and treatment might look like. Thereafter you can identify individual patients who would benefit and ensure they get that gold standard. And quite often, the best approach is to start small and build from there.

Looking to the future

So inevitably, now the NHS 75 celebrations are over, there will be plenty of discussions about how we secure the health and care system for the future. But for all the talk of harnessing “technological advances” and “transformative change”, the one thing that the NHS must never lose is its enduring connection with its patients, which has always been founded on a deep and intuitive grasp of their needs.

By strengthening our understanding of what works and providing a focus for collaborative action, my hope is that PHM can play a part in helping us strengthen and sustain this connection for the long term. Because, as you’ll see throughout this new series, the impact this can have on services, best use of resource, workforce development and – most importantly – our patients themselves is huge.

This article was prepared by Dama Barbara Hakin in a personal capacity. The views, thoughts and opinions expressed by the author of this piece belong to the author and do not purport to represent the views, thoughts and opinions of Optum.