Authors: Sir Chris Ham
Published: February 2021
The response to Covid shows that improvements in care often arise from the actions of leaders and staff within the NHS. Examples include using digital technologies to communicate with patients, repurposing hospitals to increase critical care capacity, and freeing up hospital beds by discharging patients with support from staff working in the community. These and other improvements were possible because clinical teams and managers had the freedom to make changes at pace in the face of an unprecedented public health emergency.
Partnership working was also central to the Covid response. Mutual aid between hospitals and between general practices enabled hard pressed staff to support each other throughout the pandemic; collaboration between councils and the NHS allowed more care to be provided in the community. The Covid vaccination programme drew on the combined expertise of the NHS, the army and volunteers while the private sector provided the information systems used to support its delivery.
These examples lend support to the government’s argument in its white paper on health and social care that collaboration should be the guiding principle of the NHS and its partners. They also reinforce the white paper’s proposal to reduce bureaucracy in order to create time and space for leaders and staff within the NHS to improve care. They provide no justification for the Secretary of State taking greater powers over the NHS when local decision-making and partnership working have proved their worth. https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-version
Some commentators have asked how integrated care systems will bring about improvements in care when the stimulus of competition is removed. The answer can be found in the experience of high performing health care organisations around the world. When I studied some of these organisations a few years ago I learnt that they were able to make improvements in care because they embrace cultures of commitment – not compliance - in which staff are seen as the main agents of change. https://www.kingsfund.org.uk/publications/reforming-nhs-within
Now is the time to act on this lesson and give staff the time, resources and skills to lead improvements from within the NHS. Politicians and national NHS leaders should resist the urge to reach for extrinsic levers such as targets, markets and inspection and recognise the intrinsic motivation of staff to provide the best possible care. An increasing number of NHS organisations understand this and have adopted a distributed leadership model based on partnership between clinicians and managers and with a focus on continuous quality improvement.
The other lesson I learnt from international experience was that devolution of decision making linked to transparent reporting of outcomes could play a much bigger role in the NHS. This might involve assessing the performance of integrated care systems using a common set of indicators relating to improvements in population health and the delivery of care. Publication of the results would provide transparency and stimulate system leaders to learn from each other and improve together. The sector led improvement approach used in local government, based on peer challenge and peer support, is an example of how this is already done in the public sector. https://www.local.gov.uk/sites/default/files/documents/sli-local-government-pdf--f4c.pdf
You can write to Chris at [email protected]