Comment

24.03.17

Reflections on the Strategic Projects Team

Source: NHE Mar/Apr 17

Andrew MacPherson, former managing director of the now closed Strategic Projects Team (SPT), reflects on his time in the NHS that followed a career in trains, boats and planes.

In 2006, I had completed the customer service design for the roll-out of a newly merged first of the “super TOCs (train operating company)” in the east of England. I’d previously led major change programmes for international organisations, whose origins had often been in public ownership. 

Equally fascinated by some of the cultural challenges the NHS was facing, I became a non-executive director at Ipswich Hospital, where I chaired the delivery of the new Garrett Anderson A&E and ICU Centre alongside an initiation of the trust’s application for FT status. At the end of 2008, I got into conversation with some radically different policy leadership at the then Strategic Health Authority (SHA) for the east of England and was asked to lead the process to secure the first-ever franchise of an NHS hospital, Hinchingbrooke. 

What was compelling about the opportunity was that I was increasingly of the view that the NHS was unsustainable and unlikely to improve its service proposition in the long term, given the increasing demands being placed upon its current design. I’d already seen the impact of the particularly ageing population in the east of England on the transportation infrastructure. From my experience, I couldn’t see the money adding up for the NHS, particularly in the face of the need for much higher standards and greater demand. 

I wasn't alone, it seemed. The SHA had the courage to confront this challenge, at least in the context of Hinchingbrooke, in not being prepared to simply further underwrite the former’s £38m deficit, but to seek the best possible provider through an open competition while still retaining staff and assets for public ownership. At this time, the mere suggestion that a public service was insolvent was something that had to be whispered. 

The opportunity to confront, engage and hopefully deliver was too enticing to ignore and of course, as a challenge, it now resonates so much with the ‘current’ crisis.

How did the SPT come about? 

While I had put a small team together specifically to deliver the Hinchingbrooke franchise, it quickly became very clear that there was a demand for a delivery unit with both commercial and stakeholder inclusion skills. Within weeks of starting in February 2009, I was also asked to find an operator for the Bedfordshire and Luton Mental Health Trust – there had been a series of tragic events which required SHA intervention. However, a fast solution was essential given the operational fragility and while a completely open competition for the best possible provider wasn’t an option in the time available, we did, for the first-time ever, offer the opportunity to the NHS nationally. Thereafter, we became increasingly an internal 'go-to' organisation. The SPT became progressively recognisable in name, purely by word of mouth and in demand to support business change, scaling up (and down) its resources, whenever needed. 

The SPT never worked from an ideological platform, but simply pursued, on behalf of clients, the best possible solution for both patients and taxpayers. Simon Stevens’s ‘think like a patient, act like a taxpayer’ certainly resonated with us six years later, but the competition and commercial grip somehow played to the anti-privatisation lobby. For me, though, running the NHS as a successful business didn’t mean privatising it. We have a responsibility to ensure the best possible choice of solutions, so neither the private sector nor an existing public sector provider can be excluded if it’s the best possible provider. Equally, the introduction of the internal marketing of change and tools such as real-time ‘customer’ experience measurement (like the Friends & Family Test, which we were to subsequently co-design and introduce nationally) shouldn’t be solely the domain of private commerce. 

The demise of the Uniting Care Cambridge & Peterborough Community Services contract rightly or wrongly prompted the end of the SPT, at least in name. I don’t wish to be drawn into the blame debate and I have attempted to avoid it throughout, as I don’t believe it to be at all helpful. By all means learn, but don’t assassinate. It’s also not appropriate that I comment on any commercial details.

The ‘feeding frenzy’ around the end of the contract was not, in my opinion, the NHS’s finest hour. The SPT provided just one subject matter expert to a large complex project that involved a great many people from both within and outside the NHS. We formally exited prior to contract exchange. To suggest a dominant role or arguably singularly misleading commissioners, regulators and major players in the acute sector has both questionable credibility and motive. What was made clear to me by peers, whose opinion I greatly respect, was that the SPT brand name was becoming increasingly toxic. The more juvenile elements of the media recognise how quickly they can get a roar from the crowd during the inevitable political football match (both within and outside Westminster) that these events sometimes generate. This all became an increasing distraction from our wish to make a difference, which had always been the driver since 2009. 

I’m obviously sorry that the hard work and support of the ‘imagineers’ within the NHS is sadly often thwarted. The ending of a unique, if perhaps not perfect, internal team is regrettable, particularly at a time when so much change needs to be delivered with grip, rigour and pace. It might have been better to further develop and support an SPT, rather than increasingly draw upon external resources, many of which, while excellent, will inevitably come at a premium. 

Of course, greater than any personal accolade (or criticism) has been the huge opportunity to work alongside those fabulous people who make healthcare happen, 24/7. The NHS is so often a world-class service. It has been a privilege.

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

Comments

P. Smith   27/03/2017 at 13:41

"I’m obviously sorry that the hard work and support of the ‘imagineers’ within the NHS is sadly often thwarted." Classic.

Peter S.   30/03/2017 at 11:31

A really succinct reflection of a tumultuous time for the NHS that was full of promise. It seems that innovative transactions are beginning to emerge again, CCG mergers, STP special purpose vehicles and potential outsourced locality commissioning (in all but name). All exciting developments but without any real functional team in place to avoid historical mistakes.

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