The Future's Bright...The Future's....Paul O'Neill, Director, East Midlands Leadership Academy

Wed, 02 Jul 2014

Most of my previous blogs have been around my own thoughts and musings on various aspects of leadership. This one feels a little a different – it’s a bit more of a ‘download’ from my recent attendance at the NHS Confederation Conference, The King’s Fund annual NHS Leadership and Management Summit and one or two other occasions recently where I’ve heard senior politicians, NHS leaders and others from the ranks of the great and the good (which is meant as a compliment) talking about the future of the NHS and the wider health and care system. So what follows is my own sense making of all of this and what I believe to be the opportunities that leaders need to grasp.

Educate the public and let them join the debate

The NHS Confederation’s 2015 Challenge Declaration is an excellent document outlining the challenges the health and care system faces in the next few years. It’s familiar reading and territory for those of us in the service but its target audience isn’t us – it’s the politicians and wider public. It aims to get out on the table some honesty about the challenges the NHS faces.

I don’t want us to go into another general election pretending that simply ring-fencing funding for the NHS is a satisfactory plan for the future. The service needs to change radically in order to meet the challenges that have emerged over the years and that we now face. The move from a hospital dominated, ‘repair and return’ model to a largely community based preventative, self-care and long term support model is the crux of it. There’s one crucial component to all of this and that’s to get MPs to understand the above. That way, when the necessary and inevitable reconfigurations come with requirements for hospital ‘down-sizing’ or closure , MPs are with us, engaging with the public to explain and debate why this is necessary rather than resisting change from a poorly informed perspective.

Locally owned and implemented planning

‘No more top-down re-organisations of the NHS’ – Yes, I know we’ve heard that before, and we have just lived through the biggest top-down re-organisation the NHS has ever seen but even those responsible for such radical change seem to grasp that whilst there have been some benefits to the last re-organisation (for me I would acknowledge that clinical led commissioning seems to be having an impact in the areas where it’s at its best) large scale re-organisation of the management structure rarely (never?) achieves the benefits promised and are costly and distracting.

Transforming services has to be done locally in health economies that make sense. Most patient care takes place within a radius of a few miles, it’s the integration of your local hospital with your local primary care services, your social care services and good co-ordination with the third sector bodies that are in your area that matter. This can be incentivised and even mandated at a national level but the actual planning and delivery has got to be done locally, a concept that seems to have found favour at ‘the centre’.

More sophisticated commissioning

One of the barriers to integrating services is the de-stabilising effect this could have on acute trusts in particular. Hospitals are financially incentivised to admit patients and what we’re now asking them to do is co-operate with plans that will reduce admissions. Whilst they may agree this is the right thing to do; financially speaking, it’s turkeys voting for Christmas and money aside, the breadth and depth of community services required to prevent significant numbers of admissions just aren’t there yet. There is an acknowledgment that there are perverse incentives in the current model and there is a need to try, to experiment with some different models.

Listen to the patient voice more

At the NHS Confed Conference, it was great to hear about the importance being placed on getting the culture of NHS organisations, from top to bottom, right for patients in a way which treats everyone as partners in their care and with the levels of dignity, respect and compassion that we would want for ourselves and loved ones. These words are easily said, and many have been saying them for years, but there does seem to be a concerted effort around making this happen.The need for properly trained and supported patient leaders is gaining momentum.

Parity of mental and physical health

Linked to the above is the importance of treating the whole person not just the symptoms in front of you. I trained as an Occupational Therapist 30 years ago and this was engrained into us then, but still there is a need to make this the dominant way of thinking for everyone. I think every profession would claim it trains its new recruits to do this but we all stand accused of organising services around diagnoses and professions not around people. It is a stark and horrible truth that patients with long term mental health problems die 15-20 years younger than those without such enduring ill health. We must not continue to separate to an unhelpful degree a person’s mental health from their physical health as if they are two different systems acting independently of each other – it’s a nonsense to think they do.

Healthcare science

You may not realise this but we’re about to live through a revolution with the advent of individualised analysis of our genetic makeup and equally specific individualised treatments targeting precisely the life threatening diseases we suffer from. The first human genome was sequenced (the code cracked if you like), in the year 2000, after a decade’s work and at a cost of $100bn – it’s now possible to sequence an individual’s whole genetic makeup in 47 seconds at a cost of around $1,000 and this will be less than $100 in the near future.

When the internet was first “invented”, the futurologists told us that we’d all be affected and that this advance in technology would have an impact on all of us - it was difficult for them to be specific about how but they were absolutely right! This in my opinion is very similar, what we can now understand and develop through science will have an astounding influence on how our health system works, and what patients can expect – but in what ways? Watch this space.

Care data and social media Influence

We will move to an era where much more information is shared and in the hands of the general population not just services, managers and governments. Experience so far is that swathes of the general population do engage with this, making informed choices and influencing services as they become owners and users of ever more data.

Social media will too continue to influence change (see the HSJs Health Social Media Pioneers) for some great examples. None capture this more than the very brilliant and inspiring Dr.Kate Granger ( follow her on twitter @GrangerKate) who as a doctor and terminally ill cancer patient has done us all a wonderful service through her social media campaign #hellomynameis. I really commend you to follow this link and watch her speech at the conference.

Funding

Do all these challenges mean more money for the NHS? The latest figure seems to be (if nothing changes that is) that there will be a £30bn a year funding gap by 2020, the end of the next parliament. Nobody is promising anything but at the same time, no-one can afford to ignore it. Hopes are pinned on technology and different models of care but most of us think this is only likely to get us part-way there.

The politicians seem to be saying that until there’s renewed confidence that every NHS pound is being spent wisely in a system revised to fit our new and ever more challenging generation of patients, there is no way of getting more money into the NHS. The idea of an hypothecated tax just for the service may be a way of persuading the public that increased taxation for the NHS is palatable but no promises yet on increased funding - even with strings attached.

Leadership

So what does that all mean for leadership and organisations like EMLA – aiming to develop and support leaders in the challenges ahead. I think we’ve been doing some of the right things for a while – particularly focussing on patients and compassionate treatment of staff as a way of getting good results – this needs to continue. There are a few more things we need to put increased emphasis on including:

-          Supporting leaders running local transformation projects to plan on a system wide basis.

-          Developing leadership skills in working across organisational boundaries

-          Encouraging the use of service improvement methodologies in piloting different models of care.

-          Working with commissioning leaders to help them explore how they try out new models of care and more sophisticated ways of commissioning.

-          Working with patients and patient groups to develop their leadership skills.

-          Promoting the use of social media and care data as positive forces for service development and influence

Above all, we want to enthuse our leadership community to change and revolutionise our NHS to be consistently caring and compassionate. To ensure that it’s at the forefront of healthcare science and technology; not just to become more efficient, but more open, transparent, caring and engaging.

The future could be bright.