|   Thought Leadership

Today’s announcements show that once again the NHS is wedded to an institutional response to dealing with its problems. Push the re-set button. Don’t change the software. Yet.

The NHS’s current re-set button lies in a bygone system reaction, matched to a hope for its survival and legitimacy. Much like the large corporate organisations that advise it. How many times have you recently heard or advocated that the whole system needs to respond, that system architecture needs to change, or we need Hospitals to get bigger, or systems of care to become more integrated? Or that the Secretary of State needs to be bold. (What does that actually mean?)

For many NHS professionals, nostalgia is the natural human emotion, a survival mechanism that pushes people to avoid risk by applying what we’ve learned and relying on what’s worked or not before. The system has the answer. This mindset is fixated on organisational survival-not improving health services to its consumers.

The NHS has become more conservative; it is looking to the past, to times that seem simpler, and has the urge to re-create them. But when the past has been blown away by new technology, market instability, by the ubiquitous and always-on global hyper network, beloved past practices are useless.

There is one certainty, however. The next decade or two will be defined more by fluidity than by any new, settled paradigm; if there is a pattern to all this, it is that there is no pattern.

So what do should the NHS do?

Firstly it should accept its current position & plan for the future using multiple scenarios. Some of the subsequent responses may include:

An expectation that the Conservative party remains in power, Brexit happens & the NHS could be seen as fertile ground for large US backed corporations. So we could expect to see some “epic” health records projects emerging. If policy is more left of centre, then expect clinically led integrated organisations to emerge with decentralized or devolved governance and leadership. Either way-plan for all types of political outcomes.

“Service”. Re-introduce the concept of it.

Not meeting constitutional targets is both a kop out and also dangerous for the future of the NHS.

Integration solves exactly what? If integration is the answer to service provision excellence and not just safety in numbers/too big to fail, then learn from the US experience of developing accountable care organisations. Explicitly build a strategy for giving power and autonomy to citizens and spend less time wasting money and resource on organisational form and creation. This doesn’t come from writing a public engagement strategy or hiring a Patient Director.

Progress comes from disrupting the current model of service provision by introducing absolute transparency, potentially charging for services & reframing clinical commissioning to focus on navigation. Citizens need a change of mindset, not an info-graphic with them in the middle of a donut shaped diagram. A state funded health system cannot change citizens‘ mindsets through policy interventions.

The question for NHS professionals to answer “how do you ensure that citizens with little health literacy and no understanding of NHS systems & constitutional commitments have the same experience of NHS services as you?”

The cessation of the Care Data programme is not helping to progress a consumer driven organisation. It stops consumer driven care by hiding behind information governance constraints.


Make a decision about the value of commissioning and commit to it. Is it going to replicate payor practice in the US and therefore increase costs, and develop hubs of clinical expertise and data collection and invoice validation? Or is it a loose affiliation of managers and clinicians with limited powers of leverage?

Promote Health Spending

Increase funding, but not through the current channels. The begging bowl culture needs to be phased out. The reality is that citizens may wish not to extend the remit of the NHS. A trusted brand may not be the most popular investment vehicle. (See BHS & M&S for further details, and see constitutional targets being missed above)

Organisational Culture

Promote the challenge of uncertainty instead of the warmth of nostalgia. The “system” (whoever and whatever that may be now) doesn’t have the answer. You and your professional teams have it and you can unlock and embrace the opportunities that this represents.

New Voices

Finally, the NHS needs some new voices. The same bloggers post. The same thinkers think.

The current stereotypical NHS expert is that although they are undoubtedly talented, most of them are very similar. They all bring the same type of energy. Culturally, this means it has very low difference, which almost by definition means they challenge little. The feedback loop supports sameness, and as evidenced by recent history, certainly defies progress. That’s why the NHS feels stale, and stagnant. Who we are is what we create. Stale doesn’t create innovation. Fresh creates innovation.

Succession Planning

Local Health and Social Care provision is more like a small ecosystem than a fitness factory. Health and Social Care systems are not sets of machines that can be counted, unbundled and re-engineered by process.

Sustainability in healthcare will come from leaders embracing Succession.

Nurturing top leaders in world class hospitals, being incentivised to move care out of hospitals to integrated community and primary care teams, modernising and investing in real primary care and not only “retail primary care”, and the most important of all- extending health literacy and navigation.

The NHS needs a Succession plan. A Turnaround plan is defunct.