interviews

Change management

Since the April 2013 transition, the NHS Strategic Projects Team has been hosted by the Greater East Midlands (GEM) Commissioning Support Unit. NHE spoke to its director Andrew MacPherson about its expansion across the country, his leading role in delivering the Friends and Family Test, and the need for a customer service culture change in the NHS.

The Strategic Projects Team (SPT) began life as a unit within the then-East of England SHA, formed to lead the franchising of Hinchingbrooke Health Care NHS Trust to a private company – a process that was completed in November 2011.

It went on to be involved in the design and implementation of many other major change projects, first regionally then nationally, and the team has grown so much that it now employs more than 30 people. Its stature was further enhanced when it was given a leading role in the roll-out of the Friends and Family Test, which itself started out as an idea by SPT director Andrew MacPherson and his then-colleague Dr Stephen Dunn, now of the NHS Trust Development Authority.

Upon the dissolution of the SPT’s host SHA cluster in April 2013, many other organisations inside and outside the NHS offered to host it. MacPherson chose to go with the Greater East Midlands (GEM) Commissioning Support Unit.

The CSU’s managing director Professor John Parkes said he was delighted to be hosting “a highly-regarded team which has gained national accolades for its innovative work across the health sector”.

Continuity and demand

Talking to NHE about the transition, MacPherson told us: “We were astride several major strategic projects, and so had a very clear life post-April 2013. As far as was possible at that time, we had a clear trajectory. There was some kind interest both from outside and within the NHS to make sure not only that continuity was maintained, but that we were able to continue to respond to the growing demand for the services we provide.

“All credit to the NHS that the transition, while by no means perfect, has been quite extraordinary considering the scale it operates at.”

He acknowledged that some of the challenges thrown up by the transition and the efficiency agenda have provided a workstream for the SPT, as more parts of the NHS consider strategic reconfigurations and the need for radical change.

MacPherson told NHE: “There’s a need in the NHS for these kinds of services, and we’re providing it without any seed funding or being a drain on the taxpayer.”

From its 2009 foundation to the 2013 transition, the SPT had worked on projects with a total contract value of about £4bn, which has since grown by another £1bn.

This includes its programme management work with Cambridge and Peterborough CCG on its Integrated Older People’s Pathway and Adult Community Services procurement, a tender that may be worth up to £800m, which MacPherson called “arguably one of the biggest integration projects the NHS has ever seen”.

“We’re now seeing, as a result of our work with Cambridge and Peterborough CCG, a great deal of interest from elsewhere. While they are not by any means the first organisation to do this, they’re one of the first to do it on such a scale – and I suspect that’s given several organisations the encouragement to move forward with their own strategic thinking.

“With the economic background and the increasing wish for the NHS to provide a seamless service, it’s a very obvious solution to some of the challenges that currently exist.

“We’re around to provide the best possible solution for patients and taxpayers, and to support the brave in taking those things forward – and to encourage the timid!”

Although each client it works with and project it works on (more details on page 44) has a single principal, MacPherson says the team’s scale is now such that “there is a backdrop of support and multi-skilling that allows us to draw upon expertise outside the dedicated resources that we’d committed to a client”.

He told us: “Inevitably there are challenges involved in managing growth, and in ensuring quality is maintained. The personalisation of services needs to be sustained.”

The perception that it is purely a regional team for the east of England has been shifting, MacPherson says, as it does more and more work out of that area, and now that it has established a London office at Skipton House from where Christopher Johnson leads its national pathology team.

‘Following careful consideration…’

Pathology, however, is one area where there have been setbacks. In August, CCGs abandoned the £500m pathology rationalisation and procurement project for the north-west Midlands, begun under their predecessor organisations, then their counterparts in the south-west Midlands region came to the same decision.

They blamed a reduction in the anticipated clinical and financial benefit; a new strategic direction, an increase in perceived risk, and
“a reduction in the importance of transforming pathology in comparison to other commissioner priorities”.

The SPT said then: “Whilst we are disappointed we recognise that CCGs should take decisions that benefit their members and we wholly support their choice.”

A few months on, we asked MacPherson to reflect on that disappointment. He said: “I don’t think anybody would have considered the seismic changes within pathology that we were supporting had they realised the clients were going to change in mid-stream from PCTs to a whole range of CCGs. So we’ve had some disappointments there. We’ve done everything that the client, old and new,
has asked us to do. We’ve delivered on all of that. But there was a loss of appetite; a mixture of a review of decisions made prior to April 2013 by the old commissioning bodies, combined, frankly, with demands on bandwidth that the new commissioning landscape inevitably was faced with.”

He added: “We also feel sorry for the market, be it NHS or independent sector, who were very patient.

“But the rationalisation of pathology services is so blindingly obvious a solution, if it can be managed properly, that we’ve now got commissioners who rejected the original PCT intentions approaching us to discuss their own alternative models to achieve exactly the same thing. So the concept can’t be completely wrong, otherwise people wouldn’t be re-visiting it, and they can’t be too disappointed with us or they wouldn’t be asking us to do work with them!”

The pathology project in the East of England is progressing, despite delays, with “three and a half” of the four contracts in place. 

Net promoters

The explosion of interest in the Friends & Family Test that led to it being ‘adopted’ by prime minister David Cameron and designated a national statistic has involved huge amounts of hard work for MacPherson and the rest of the SPT.

He was made director of strategic projects & delivery for the project at NHS England in April 2013.

He called it a “big win”, with 2m responses to the test already (when the pilots and legacy Midlands & East SHA work are included).

He added: “The bottom line is, all 160-plus acute providers started to report under FFT on time, on target, in April 2013. Maternity services equally started to capture the information on time, 100% of them, in October of last year. We facilitated all of that, and we completed the draft guidance for all other pathways on time and on budget for NHS England.

“None of those projects are for the fainthearted, and it’s a testimony to what the NHS can do when it pulls together. I can only praise the providers we’ve worked with for achieving this customer-centric culture change: there’s been some great progress there, although there is a lot more to do.

“When NHS England is up to full capacity, they will manage this on an ongoing basis from the centre. We will continue to provide regional support in terms of delivery, in several areas, not least the Midlands and East, and working with providers directly.

“The SPT, with the help of former colleagues like Dr Stephen Dunn and Sir Neil McKay, has broken the mould and delivered the concept of near real-time patient experience feedback.”

He said he was thrilled with the praise the FFT had received from Tim Kelsey, NHS England’s national director for patients and information.

Culture change vs performance metric

We asked MacPherson how happy he was with the final implementation and wording of the test, when compared to the initial 2011 vision.

He said: “It would be very selfish of me to want a national standard to reflect exactly Andrew MacPherson’s personal viewpoint. Certainly there’s been tension, inevitably, given that the test was primarily set up as a catalyst for culture change. It’s what the King’s Fund referred to as a ‘tin opener’. But its designation as a national statistic has inevitably given a connotation of it being a pure performance metric.

“It has its value as a performance metric, but that isn’t the dominant purpose, and the traditional interpretation of performance numbers within a healthcare environment (and arguably throughout the public sector) is as a ‘stick’. We want it to be a ‘fire’, something that’s a catalyst, driving the passion for customer service excellence within healthcare.”

“I love competitive tension, and human nature being what it is, and based on my experience in applying these kinds of change
mechanisms in other industries, most people like to know how well they’re doing. If delivered properly and presented properly, to cheer people on, and to be seen as a mechanism for catching people doing things right, it can work extremely well in terms of
productivity and improving the experience and perhaps driving out poorer quality that might exist in the service. The tension comes in terms of it being seen as just a ‘numbers game’ in which you are beaten over the head by national media.

“For those people who do ‘get it’ – and there’s a huge amount who do – the concept of accessible, transparent data available to all in near real-time is a huge leap for an organisation of this scale… People love this and are celebrating it despite the political dimension; ownership by the premier of the country is hugely flattering, but it does put another dynamic in place!”

Of the NHS, for the NHS

We asked MacPherson to expand on his team’s status within the NHS and its business model as a hosted unit.

The SPT is still an NHS body, an “intra-NHS service” as MacPherson puts it. “That was unaltered in the course of the transition. We’re not in the business of making a profit, but the fact is, we’re hosted by a CSU and obviously there needs to be a return to that CSU for the support and the platform they provide. And we’ve got to remain competitive.”

MacPherson is now looking to the future, with a new reconfiguration programme in mid-Essex and ongoing change management work with Weston-super-Mare and George Eliot trusts alongside many other projects (more information on page 44).

MacPherson’s background before coming into the NHS was in customer service roles in other sectors, including transport, and he said: “It’s the National Health Service – the clue is in the name.

“It’s a world-class healthcare organisation. But its scale presents challenges, and it’s maturing at pace given the economic challenges it and other public sector organisations face. That inevitably means that there are lots of things to do in terms of change management.”

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