Jul 23, 2014

Overcoming the NHS Funding Gap: Changes & Collaboration


All areas of the NHS are facing a period of massive change and with it uncertainty. Many consider the current funding restrictions on the NHS as a defining moment in its history. To overcome the NHS funding gap Simon Stevens, the new head of NHS England, wants to create a culture of innovation and solutions based on the principle that 'necessity is the mother of invention.'

As an example an increasing proportion of hospital funding from NHS England and local Clinical Commissioning Groups will be explicitly tied to prevention, quality of care, and patients' own views. The way GPs, local hospitals, social care and community health services work together will also be radically redesigned.

"Stevens view is that we need different solutions for diverse communities and a one-size fits all system in no longer tenable," said Paul Jarman, managing director of ROAD. "It's up to providers to make sense of their local economy, build relationships, work in partnership, and create new ways of working together. Collaboration and on local and regional services will be the key to success."

The changes now under way in every health economy in England due to the 2012 Act and the national economy are forcing all providers to reappraise how they will work with their colleagues locally and system leaders regionally and nationally, and how will they explain the likely consequent changes in provision to their communities.

Both patient and commissioner choice and the advent of a general election campaign in which the NHS will be a key issue mean that the local reputation of an organisation is perhaps more important today than ever. Reputation is not only the story others tell about your organisation, it is the story your organisation tells about itself - internally and externally.

The old school of reputation management in the NHS was too often defensive, focused mainly on minimising noise and bad news. The three unwritten laws of old-school NHS management were '1. Don't kill patients in such numbers that people notice 2. Don't blow all the money and 3. Do keep any noise that might embarrass the minister down'. These were the products of a NHS highly-centralised on regional, ministerial and DH fiat, which was in no small measure responsible for unfortunate, insular and bullying aspects of culture that contributed to well-known tragedies in patient care, as the reports of Robert Francis and Don Berwick suggested.

The plumbing of power inthe NHS is now considerably more complex, legislatively and practically (although highly centralising impulses still exist across the new system leadership hierarchy).

More broadly, the world of public service provision has changed since the 2000 Freedom Of Information Act, the widespread publication of NHS performance data and the rise of social media. Stakeholders in the NHS and the care economy face massive challenges as demand rises while funding is essentially flat or (if you see the Better Care Fund as removal of money from the NHS falling. Candid conversations about these challenges within local health economies are absolutely unavoidable. They should therefore be embraced, as should a far greater level of public dialogue. (NHS England's decision to webcast its board meetings sets a positive example of this.)

The NHS's traditional approach to changes and reconfigurations of services (inevitably painted as cuts or closures) tended to formulate plans secretly without public involvement or engagement, and then present those plans with a veneer of public consultation to prevent against getting a judicial review, and with no real intention to change the plans. Consequently, public confidence in NHS service changes is not high.

Hospital providers have been one of the most stable parts of the NHS throughout its many management reconfigurations, and the 2003 Health and Social Care Act gave successfully-authorised FTs important freedoms. Whoever wins the May 2015 election, it is unlikely that the NHS will be able to spend its way out of the challenges of meeting the health and care needs of an ageing, fattening and increasingly co-morbid population. Providers will have to start to think imaginatively and on the basis of data as they plan their course from the 2014-15 financial year to the end of the decade.

Providers who do not have candid (and sometimes difficult) conversations with their local and national partners and stakeholders, and who do not fully understand how they are perceived by their partners and stakeholders, will be at a significant disadvantage in making their plans. Any provider must also have open and constructive dialogue with its key internal stakeholders - its staff - if it is to adapt successfully. One defining principle of doing this well and sustainably is to listen as much as you broadcast. Another is to implement confidence-building measures at a very early stage of the process.

Changing health and care provision is not likely to be straightforward, but without making appropriate stakeholder consultation and engagement part of a provider organisation's core business, it is likely to be much more painful than it otherwise might.

Jul 23, 2014