The playing field of the NHS has changed, but the people on the ground can still establish a positive working culture by talking less and doing more, says Ciarán Devane
The transition to the new English NHS has happened. With bumps, but it has happened. Many long-serving and admired colleagues have left. Others are in new and challenging jobs. Yet more are in similar roles, but being told that how they do that role has to be different.
Clinical commissioning groups are getting ready to commission; their support units are developing their specialisms; local area teams are learning how not to be strategic health authorities. Everyone is working out how to use health and wellbeing boards to collaborate with local authorities. Broadly, the structure is in place.
‘We need a big number and good story in the NHS if we are to win the hearts and minds of the public’
What is not yet there is the culture. Culture is established ways of working; tacit knowledge of how to get things done; relationships that will see people through disputes; or shared visions of what the world will be like. But even here, there are more than glimmers of hope.
I have recently visited the Queen Elizabeth Hospital at King’s Lynn to open an extension to the Macmillan chemotherapy suite (the extension being a symptom of the increasing incidence of cancer in an ageing population).
What I found most interesting was that whether it was the staff nurse, the chief executive or the chair, everyone was clear that the future of this small district general hospital was to provide the right services beyond the walls of the hospital and to invite other services in − to operate as a health campus.
Diabetes consultant Partha Kar recently gave me another good reason to hope in his personal blog. He was invited to Gateshead to talk about innovative models of diabetes care and was delighted to find himself in the room with people from the CCG, the hospital and the CSU. What struck him was the “sheer will to make the necessary changes”.
Day for change
The best example, however, has to be more than 189,000 people pledging to make a change to benefit patients as part of NHS Change Day on 13 March. From 15,000 people supporting a pledge to help staff learn from patient experience and safety, to one individual promising to go and say “thank you”, NHS Change Day showed the sheer quality, professionalism and goodwill in the NHS waiting to be released.
‘We all roughly know what needs to be done and we all want to do things that will move us in the right direction’
Importantly, the day was not a top-down motivational idea. It was created by junior clinical staff, gained the support of a great sponsor in the chief nursing officer for NHS England, Jane Cummings, and went viral because enough NHS staff wanted it to.
So if I am right, we all roughly know what needs to be done and we all want to do things that will move us in the right direction. So why don’t we? Partha has some of the answer in his blog when he says “talk less, just do”. More specifically, he has three concrete suggestions.
- Use the “national” in the NHS to learn from others.
- Act before the model or the system is perfect.
- Work with people who just want to do something for patients, not people who hold too firmly to a particular stance.
I suspect we will individually but cumulatively make a big difference if we do those three things. But for the wholesale system change we need, on the timescale we need it, we need to do more.
Getting the message right
We need a narrative, a story, a message. One that we repeat consistently. No one ever hears a talk from me without me saying, “There are 2 million people with cancer in the UK today, and by 2030 it will be 4 million and therefore we need to…”
We need a similarly big number and good story in the NHS if we are to win the hearts and minds of the public, and have them on our side when we approach some of the harder changes.
One promising sign is the clarity of NHS England’s A guide to our vision and purpose document, which goes to the board soon. Reading it, you can actually understand what NHS England thinks about itself, what it thinks is important and how it wants to approach things.
The second thing we need is related to having a strong vision. It is the strategy and plan that will make the vision a reality.
‘We have to make it easy to do things, to get the organisation out of the way of itself’
Broadly, there are two ways to build strategy. There is the deeply analytical approach, which is very rigorous and highly quantified. And there is the hypothesis-driven approach, in which you test the hypothesis for truth, and then spend most of the time working out what the barriers to implementation are and bringing people with you.
My suspicion is that NHS organisations need less of the former and more of the latter. After all, we could broadly describe the principles behind the NHS of 2030 now.
But a clear narrative and a clear plan are not enough. We have to make it easy to do things, to get the organisation out of the way of itself.
Some of my colleagues in specialised commissioning are being frustrated at the moment by procurement rules that mean they cannot buy in the skills they need as the particular team they want to commission is not on the right list. So an entire transformation is on hold.
Google has a phrase it uses in describing its business model and internal culture. It says its role is “reducing friction” as you access information. So if you google a restaurant, unless you ask, it should be for the town you are in, and if you have no history of ever clicking through to the ones with prices starting from £50 then these should probably not be at the top of your search results.
‘Part of what the new NHS should do quickly is change a few things that just make life easier’
Similarly, Google believes meeting people from other parts of the organisation is a good idea for staff, so it mixes up where people sit and gives free lunches in the restaurant, knowing that this will increase collaboration.
So my belief is that part of what the new NHS should do quickly is change a few things that just make life easier. Scrap a few reports, simplify a few forms, abolish a few rules, question more, and, perhaps at times, rebel. Release people’s time to do good things and those good things will happen. Encourage them to test and learn, not to analyse themselves into stasis.
None of this optimism is to say there is not risk. The NHS is under pressure; the reforms are hard.
But if the new world is about change and collaborating for that change, later will be no better a time than the present to just do it.
Ciarán Devane is chief executive at Macmillan Cancer Support
Ciarán Devane will be speaking at the Commissioning show at the Excel in London on 12-13 June. For more information and a full list of speakers visit the event website.