Chris Roebuck reports on the views from the NHS Employers conference

The meeting of minds apparent at the NHS Employers conference was encouraging given the difficult times the service is facing. The challenge is whether this meeting of minds can develop into action across the NHS that makes a real difference to a significant proportion of staff and thus to patients by delivering a sustainable change.  

My conversations with those at all levels and backgrounds, from HR directors, to union officials, from Darzi fellows to chief executives, from professors to nurses, from external advisers to well-known speakers, all revealed a common desire to turn some of the exceptional initiatives showcased into the norm across the service.

There was a consensus that exceptional leadership and partnership working across boundaries are vital to review and optimise processes and to engage staff to deliver top level performance.

Leaders need to take a “serve to lead” approach enabling their people through development, inspiration, and improved wellness to deliver the best possible quality and value. Leadership has to align effort with key deliverables at all levels.  

There was a sense of urgency that the time for discussion and debate had passed and action was now required.          

From a strategic perspective, although the service has a level of structural, cultural and stakeholder complexity no private sector organisation can rival, that does not mean the solutions have to be complex as well. This was confirmed by those responsible for the best practice case studies where simple and practical local initiatives derived from overarching strategic principles in the NHS constitution produced significant benefits.

There was also a consensus that sometimes there is an expectation at local level that solutions will be provided from either the SHA or the Department of Health and that until that occurs it is best to wait and do nothing. 

Conversely, many thought the service sometimes makes things more complicated than they need to be, which hinders successful delivery. This was well summarised by DH director general of workforce Clare Chapman’s quote from an NHS professional who said: “I love my job but too often the system gets in the way.”    

Communication across boundaries was thought by many to be the key to creating an integrated health system where partnership working is the underlying culture - partnership between separate teams, between primary and secondary care, between clinicians and managers, between the NHS, local authorities and the third sector. But there was some concern expressed that this wasn’t happening fast enough.

An example was the general need to increase communication and understanding between junior clinicians and junior managers. This, in the words of those who had been asked to showcase their success at the conference, would either seem too daunting to deal with for some colleagues or others would make it balloon from a simple invitation to people to meet at lunchtime to discuss key issues into a fully fledged initiative requiring a planning committee, board papers and approval, external facilitation and tender - all at significant unnecessary cost in terms of time and resources.

There was a strong view that in future a “can do” culture, focused on delivering simple practical solutions, had to be the way forward.   

Most believed the way to meet the leadership challenges of the future would be for the principles in the NHS constitution to be developed by the National Leadership Council as guidance and used as a catalyst for action for many different challenges facing the service. This would position effective leadership as the critical enabler for delivery of key objectives, a “need” to have not the “nice” to have it often is.       

There are many excellent people in the service who take the initiative and keep things simple and patient focused. These champions must be supported and their approaches shared more widely. Taking the initiative within strategic guidelines is a key leadership responsibility. “What should I be doing differently and how can I take the initiative?” should be the question everyone asks every day.                

The key messages from the speakers and those from the frontline trusts showcased as examples of success were:

  • Leadership is key, “serve to lead”. Leaders should engage, support and develop staff at all levels.
  • Keep it simple and patient focused.
  • Quality and value are not mutually exclusive - you can have both.
  • Communicate, communicate, communicate - across boundaries to build real partnership working.  
  • Always ask “what should I be doing differently and how can I take the initiative?”

These can implemented by everyone and with no cost. Don’t wait - start to make a difference now.

And never let “I love my job but too often the system gets in the way” be words ever heard in your organisation. Those who attended the conference should now go out and champion the enthusiasm, simplicity and clarity they demonstrated in Birmingham to others to make a real difference to the NHS.