Transformational change often falls at the first hurdle but it doesn’t have to if policy flexibilities, organisational capabilities and leadership behaviours are addressed, write Mike Farrar and Tom Hampshire

As the NHS responds to the opportunities outlined in the five year forward view, a shift in approach is needed if the new models of care proposed are to be successful.

Mike Farrar

Mike Farrar

Why do things need to be different this time?

Because when taking on transformational change of this nature, especially the two population based delivery models of primary and acute care systems (PACs) and multispecialty community providers (MCPs), too often providers, commissioners and regulators fall at the first hurdle:

  • they demand that benefits come immediately;
  • they don’t allow any mechanism for learning, improvement and innovation;
  • they underestimate the strong and determined leadership required; and
  • they undervalue the importance of relationships.

They also focus on obtaining an unrealistic level of detail before proceeding, rather than managing the inevitable uncertainties of transformational change.

What makes us confident of the need for a new approach are the exceptions to the rule that exist across the NHS and internationally.

To deliver transformational change it is critical to identify the policy flexibilities, organisational and system capabilities, and the leadership behaviours that it takes to make either the PACs or MCPs model work in the NHS.

A system to keep people healthy

These include longer term outcome based contracts; workforce flexibility; deep understanding of value so that each pound delivers the maximum; the ability of leaders to think systems, not organisations; and to connect to their local population in a different way.

Go to Alzira in the Valencia region – where a hospital system is collectively incentivised to keep people healthy, well and out of hospital – and you will see all of these in abundance.

As the NHS comes to terms with the two main capitation options of PACs and MCPs, we will see local leaders manoeuvre their organisations into prime position.

Tom Hampshire

Tom Hampshire

But inherently we know that to make these options work, we will need them to apply an evidence base, develop new leadership approaches and agree policy and financial flexibilities for their systems.

The right solution for each locality will depend on the nature of the system and the capability of its leaders.

Getting the mix right will be critical to making the most of the transformational opportunity the forward view offers the NHS.

At PwC the health team are actively engaged in working globally to understand, support and develop effective approaches to population health management.

Through our knowledge of different approaches we are already helping some English systems to work out how best to implement these models and the opportunities for improved health and care they bring.

Mike Farrar is a member of PwC’s health industries oversight board and Tom Hampshire is PwC’s UK health and care transformation lead