Reflections from HSR UK Symposium 2017

A couple of beautiful summer days were the backdrop to another HSR UK conference, and plenty of highlights as usual. HSR UK manages to pull in some great plenary speakers, and this year was no exception.

Martin Roland gave a potted history of NHS politics to a wonderful soundtrack of black and white film of key figures from the early years of the NHS. Despite the grainy production and the Mr Cholmondley-Warner production (the films, not Martin), some of those words had a very modern resonance, as they talked about the pressures on the system and GP workload. Even then, it was very clear that discussions about the scope of the NHS and the standards to which it would be held would be a defining feature of debates for years to come. Martin’s measured conclusion was that getting the politics out of the NHS was unlikely, and that for all the talk of transformation, ‘muddling through’ was likely to remain the response. Not exactly a rallying call for the masses, but a tough one to argue otherwise.

The discussion of Brexit (led by Tamara Hervey and Nick Fahy) gave another slightly depressing take on the complexity and costs of the process by two people with first-hand experience of working in the EU. A more positive ‘take home’ was the call to arms for the HSR community to ‘be experts’ and inform the process, given that so much is yet to be decided. And we were warned not to restrict our focus to our immediate concerns – the sense of injustice that may have driven the vote needs to be taken seriously and clearly has a health dimension.

An early start on the Friday saw a head-to-head as Nick Freemantle and Rachel Meacock presented ‘different’ viewpoints on the infamous ‘weekend effect’. Nick’s talk touched on the statistics and the politics and he reiterated his view that at least some of the effect is genuine. Rachel gave a masterclass in making complex ideas accessible as she focussed on the artefacts. I’d have to score it as a ‘draw’ (an option that isn’t available to the poor policy maker). I do wonder if this fascinating debate distracts attention from the linked analysis showing that even if it the weekend effect was real, intervening to reduce it would not be cost effective.

Research impact continues to get attention and a session by Jonathan Grant and Jo Rycroft-Malone gave many useful pointers to a research community eager to learn the optimal strategies. Grant’s talk was both optimistic (health research gives a good return on investment, even under hard headed Treasury calculations) and pessimistic (he felt that the issue of ‘research waste’ was one to which we needed to attend).

Of course, you can never get to all the sessions you want to, but as always there was an eclectic mix. The session on patient experience brought together slew of NIHR HSDR studies and generated plenty of insights. Louise Locock made a powerful argument that the transformation of raw patient experience to ‘data’ was not without its costs, and made a plea for taking staff experience of patient experience seriously. Laura Sheard highlighted the inequity of access in patient experience data, the data being generated about front line staff but provided to more senior management.

I contributed to a session on integrated care, and there was a fascinating discussion of risk modelling and it use and value. The combination of risk assessment of older patients by algorithm and management by multidisciplinary team has such face validity, but the evidence continues to paint a far less impressive picture of its impact. Is it a technology that we just haven’t got right, or fundamentally flawed?

This only touches on the breadth of content at HSR UK, which is always 2 days well spent. At the first session, Naomi Fulop asked who was attending for the first time and there were many raised hands. Why not join them next year?