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Fit for the future

Richard Jones, health director at transformation consultancy Moorhouse, follows up his article in the November/December 2013 edition on ‘Keeping NHS services healthy during enormous change’ with data from a new survey looking at the future of the NHS.

There has been much recent media interest in the increasing levels of spend on locum doctors in accident and emergency units across England – rising 60% in the last three years.

Rightly or wrongly, this has been flagged as a further indication of problems in the NHS and the ongoing major transformation. As I mentioned in my last article for NHE, whilst A&E is the most visible barometer for the effectiveness of a local system, it isn’t the only gauge of the longer-term efforts to strengthen the health system as a whole. Rather than focusing solely on immediate performance issues (however critically important they may be), it is essential to also understand how the system is coping with the broader implications of change and whether the reorganisation is meeting its objectives.

The scale and depth of change within the NHS is so radical that the anticipated fully functioning state remains several years away. Organisations therefore face prolonged uncertainty before they can be sure of how their respective roles align with, and contribute to, the intended strategic goals for the sector. Therefore, it is important for leaders to understand what is and isn’t working as these changes are implemented.

We commissioned our ‘Fit for the future’ research to understand more about how healthcare leaders are coping with the implications of the transformation programme for themselves, their organisations and the sector as a whole.

Our survey of more than 150 senior leaders in the NHS and from across the health sector identified concerns about the effects of the reorganisation. The transformation is designed to tackle major issues by promoting patient-centred care, bringing accountability for commissioning closer to patients and improving healthcare outcomes and efficiency.

Our survey found that only 42% of leaders are optimistic about the ability of the NHS to deliver high quality and cost-effective care over the next five to ten years. And fewer than 30% see a positive impact on their ability to deliver efficiency savings. Only a third of senior leaders believe accountability for patient care has improved.

Given that our survey has been undertaken during the first year following the biggest reorganisation in the history of the NHS, it isn’t surprising that senior leaders have noted significant challenges. In our experience, in any sector or organisation, major change is difficult to get right and the intended benefits cannot be realised straightaway. As a transformational programme of this scale progresses, there will be delivery tensions as resources are diverted towards ensuring its successful implementation. There will also be productivity challenges, as people have to adapt to new and unfamiliar roles.

Our report identified three main issues facing the health sector:

1. The absence of a clearly communicated vision is creating a disconnect within and between organisations across the sector.

2. Across the sector, change is not being managed effectively, risking failure  in realising the transformation’s intended benefits.

3. Uncertainty around how to collaborate across the sector is decreasing organisations’ ability to deliver joined up solutions.

Major change is naturally a big challenge; analysing the success of the change thus far and making adjustments is an important step in ensuring that new system is effective. This is especially important when considering the NHS is now more fragmented. Organisations now have a much greater reliance on other bodies to deliver their objectives and services within the new system.

At this critical stage in the reorganisation programme, leaders in the NHS must consider the problems they have identified in the survey.

Firstly, there are steps that can be taken to communicate a clear vision. It’s hard to underestimate the importance of this for an organisation. Staff must know how the system is changing, what their organisation’s new role is and how they personally can contribute. Effective communication is the means by which staff, management and external stakeholders can take responsibility for the delivery of strategy at all levels of the system.

Secondly, leaders in the NHS must promote a culture that supports change by ensuring that staff understand why change is required and that it is a consistent feature in any successful organisation. By identifying the capabilities that the organisation possesses and where the gaps lie, change expertise can be built into the core of the organisation and effective resource planning can take place. This will empower all staff to engage with the change programme and help deliver the final vision.

Finally, it is crucial that leaders ensure that a collaborative attitude lies at the heart of the future health sector. Mapping an organisation’s relationships with those organisations it now relies on to deliver its strategic objectives is the first step to developing a mutual understanding of role and requirements. Developing and maintaining relationships with partner organisations is now, more than ever, a critical success factor for the future of the sector.

These issues are a natural part of transformation – it is too soon to know whether the reorganisation will be successful. However, as we approach the year anniversary of the new system, it is an opportunity for leaders to take stock and to ensure their organisations remain aligned with the overarching objectives of transformation.

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