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Hancock: Ineffective NHS ‘fetish’ with project pilots must be replaced with ‘agile iteration’

We have to fight against the NHS’s “fetish about piloting everything” and instead implement a system of “agile iteration” where projects are tested, learned from, and expanded organically over time, the health and social care secretary has argued.

As part of an exclusive interview broadcast at the NHS Providers conference this morning, Matt Hancock admitted that he is “sceptical” of the government attitude towards piloting new ways of doing things, which often leads to forgotten projects – even where their pilots were successful.

“If I were to go out and say I’m against piloting, people would throw their hands up and say, ‘oh my God, he doesn’t want an evidence base.’ And that’s not it at all; it’s the opposite,” he explained. “It’s that, when I’m launching something, I prefer to launch a ‘Wave 1’ – so you don’t have to get to the end of a long project and then have a review, usually by an external consultancy, and then decide whether to continue.

“What you do is, you try something out, you test it, you take the evidence, you iterate, you change it, you try it differently after having learned the lessons – or exactly the same if it’s worked perfectly – and then you expand it gradually and organically over time. That is a far better way to learn.

“One of the big problems I’ve been really surprised about in the NHS is how many things get piloted and how infrequently even successful pilots get taken up – because maybe the budget isn’t there anymore, or maybe nobody else heard about it, or whatever it is. The promulgation of good ideas has been really poor and needs to change,” he continued.

“And part of the reason is a fetish about piloting everything as opposed to learning from successful Wave 1 projects, iterating and changing where necessary, and then getting that roll-out. Roll-out, roll-out, roll-out.”

The integration debate

When asked by NHS Providers boss Chris Hopson where he stood on the integration debate, Hancock did not hold back either, throwing his support behind the concept of collaboration over competition.

“It isn’t just about the integration of health and social care, vital as that is. It’s also about the integration of different parts of the NHS, frankly,” he pointed out.

“I come from a broadly free market background, but I’ve also seen how, if you have enforced competition where in fact you can get more value out of collaboration, you put in place siloes and boundaries that mitigate against people working together – and I want to reduce that.”

The secretary of state added that he is excited about the prospect of integrated care provider contracts, which NHS England is currently consulting on.

He added: “Everything I’ve been, I have seen the opportunities that people have told me about for better collaboration. We’re going to try it in some areas, and some areas are more mature in terms of the relationships on the ground, and we’ll iterate on it. We’ll see how it works and then keep progressing.”

(Top image c. Stefan Rousseau, PA Wire)


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