Our NHS is in trouble: only strategic thinking will plot a route to recovery

The pressures currently facing the NHS are widely known: constraints on resources; staffing shortages; declining performance; ever-increasing demands on services. These perennial problems no longer feel sensationalist but alarmingly real and ever-present. Yet, common responses such as outsourcing activity or introducing locum staff, are too often reactive and short-termist, addressing the symptoms rather than the roots of problems. NHS leaders need to change their approach if they are to deliver sustainable and progressive solutions for affordable and effective care.

Make Time to Think

Carving out time in diaries to step out of the operational frenzy of the NHS can seem an impossible task. This is particularly true for doctors, who are subject to the added pressure of a relentless pursuit for greater medical productivity. Yet without their involvement, complex decisions about service delivery cannot be progressed or implemented successfully. Whilst consultant job plans are often used to maximise patient-facing time, they could also provide protected space for clinical engagement with service development. If Trusts can recognise the value in this investment, and capable management resource is in place, they will be in a much stronger position to develop an effective strategy and then turn it into action.

Develop an Analytical Workforce

The process of evidence-based planning is integral to the wider medical profession, but is too often absent in managerial decision-making. Leaders at all levels must have the analytical skills and mind-set that make exploiting the extraordinary richness of available NHS data second-nature and indispensable. This requires recruiting and training a reinvigorated administrative workforce that is fully equipped to consider both the human and statistical dimensions of a problem. From scheduling theatre lists to re-designing whole systems, healthcare management would be transformed, benefitting immediate operational performance as well as long-term service development.

Create a Forward-Planning Environment

Of course, this is all easier said than done. Indeed it is only truly possible once an operational culture is embedded in which leaders are facilitated, encouraged and ultimately expected to routinely consider and evidence the long-term implications of their decisions. Policy can help. The Sustainability and Transformation Plans[1] currently in development, and the movement towards multi-year commissioning models in areas such as Greater Manchester[2], both offer great examples of creating the space for outcomes that may take longer to be delivered, but will ultimately be vastly superior in scope and impact.

This trend now needs to be translated within providers. Executives must spurn the tempting and immediate returns of expensive short-term options, and direct their teams to develop and implement robust medium- and long-term solutions. This will require confidence, conviction and leadership. There will undoubtedly be risks – to reputation and credibility – and difficult cases to be made. But the benefits of this change in approach to patients, taxpayers and even the operational integrity of institutions themselves, are surely worth pursuing.

[1] https://www.england.nhs.uk/wp-content/uploads/2016/02/stp-footprints-march-2016.pdf

[2] http://www.gmhsc.org.uk/assets/GM-Partnership-Commissioning-Strategy-FINAL-DRAFT-April-2016.pdf

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Author

Adam Igra Manager