NZ-UK Link Visiting Fellow Professor Robin Gauld launches his lecture series

Thursday 23 October 2014

Is the UK’s National Health Service (NHS) unsustainable? Why haven’t recent rounds of reforms worked? Visiting professor Robin Gauld, from the University of Otago, provided some answers during his first public lecture in London yesterday (22 October). Entitled The current English NHS reforms: what can be learned from NZ?, it is one of four he will present while at the School of Advanced Study (SAS), University of London.

The authority on health systems based his arguments on ground-breaking research in New Zealand. He told his audience of international guests it was impossible to reduce an institution as complex as a public health system to any one, simple formula. In New Zealand, he said, sophisticated and dynamic alliances were required - structures and relationships that recognise and accommodate such complexity.

He confirmed New Zealand faced similar problems to the UK. But after experimenting ‘widely with different forms of governance and service organisation’ what emerged were alliances, a hybrid of top-down and bottom-up governance. And he revealed that the Alliance Charter ‘outlines rules of engagement and commits members to:

• act with honesty, integrity and aiming to build trust in one another
• work collaboratively, make decisions by consensus and resolve disagreements cooperatively
• adopt a patient-centred, whole-of-system approach and make decisions on a best-for-system basis
• make the best use of finite resources in planning health services to achieve improved health outcomes for our populations’ 

During the presentation, Professor Gauld said that ‘alliancing’ was not yet fully tested but the journey had begun. However, ‘By getting “everyone in the room”, alliancing is facilitating clinically led conversations about care design and delivery previously not possible; it is allowing us to look at how the system should function from a patient and professional perspective.’

We are living in an age of ‘experimental governance’, he added. Now we have to move beyond ‘hierarchical forms of control and silos to “harmonisation” of interests of different actors in the health system’. He warned, ‘This is messy but part of the transition to building clinically-led, whole-of-system approaches.’

‘The alliance model spells what is possibly the most fundamental shift in how service design and delivery decisions are made in New Zealand, since the current institutional arrangements were set down post-1938 in seeking to create a national health service,’ explained Professor Gauld.

‘It brings together clinical leaders to focus on the whole system, not just their place in it. I believe it has considerable utility for policy makers elsewhere who are focused on integration and innovation, such as in England’.

The debate was hosted by Nicholas Mays, Professor of Health Policy at the London School of Hygiene and Tropical Medicine. Dr Judith Smith, The Nuffield Trust’s senior policy director was the formal respondent to Professor Gauld's presentation.

Other guests included Francis Dickinson (Department of Health), Catherine Rushford (HM Treasury), Edward Cox (NHS clinical commissioning groups), Nick Timmins (Kings Fund) and Harriet Maltby (Legatum Institute).  Rob Taylor, the Deputy New Zealand High Commissioner was also in attendance, as was Sir Graeme Davies chair of the NZ-UK Link Foundation.

Professor Gauld will be based at the School of Advanced Study until the end of December 2014. His lecture on clinical governance at Senate House on 27 November, is the last in the series analysing the movement of healthcare professionals between New Zealand and the UK.

NZ-UK Link Foundation Visiting Professorship programme of public lectures October-December 2014 flyer [PDF]