“The future of health”: Sir David Dalton

4 December 2014

Be optimistic, be bold

There can be no doubt that providers of NHS care are facing challenging times. I have heard many gloomy predictions about the future, and I of course recognise that resources, previously used to lubricate the delivery of change, are no longer as freely available. I would, though, like to offer an optimistic outlook based on involving staff, developing a new entrepreneurial spirit and creating a new focus for population health improvement, all of which will offer greater value to the patient and the taxpayer.

I have confidence in the abilities of NHS staff. I know that the ideas for change and improvement are to be found deep inside the organisation. At Salford Royal, we encourage staff to test and measure whether a change in a practice results in an improvement or not. If it does we seek to replicate it and then measure to see if we can achieve the same improvement elsewhere. If we can, then we “reset the system” and every ward or department adopts the change package which we audit regularly to prevent regression. Our systems are now being regularly tested and changed by staff themselves using a disciplined methodology.

It is my view that staff empowerment, encouragement and support is crucial to how an organisation can find better ways of improving its care and its costs. The difference in outcomes and productivity between an engaged and a disengaged organisation is considerable, some say up to 20 per cent. We know that staff discretionary effort cannot be commanded: it has to be freely given. Creating this culture requires leadership attention, and a fundamentally different approach in many organisations, but the results can be significant. Leaders must make sure that they minimise the disconnection between themselves and staff, and that they achieve real alignment between the goals and values of an organisation and the individual contribution of each member of staff. This is the fundamental cultural requirement which will deliver success over the next five years and beyond.

Many European countries have pursued the standardisation of best practice; of back office functions and procurement; of care pathways, enabling standardised workforce redesign; of rapid adoption of innovative technologies, and of deployment of improvement methodology. All of these have enabled delivery of services at a lower cost overhead. It is perplexing that this approach has not been pursued at scale in England. It’s time to change the NHS leadership mindset and to think beyond the current ways of doing things.

Leaders of successful organisations should be “system architects”, using their social entrepreneurial spirit to develop innovative solutions to their challenges, and to codify and spread their success so that the best standards of care can be available, reliably, to every locality in the country. I very much hope that boards will be aspirational and develop an “enterprise strategy”, utilising innovative approaches for growth to deliver better care for patients.

In my review, I recommend a system of “credentialing” for our best organisations. This new “kitemark”, beyond foundation trust status, would enable commissioners to identify those organisations with the capability and greatest likelihood of successfully spreading their systems into organisations that are in persistent difficulty. This can bring a new approach to reducing the variations we have across the country in standards of care and to do so at lower cost.

Much is being spoken about the benefits of integrated care models. I agree with this. However, imagining different care models, which can deliver value to patients and taxpayers, is quite different to delivering these new organisational forms. In Salford, we are comparatively well advanced in creating our “integrated care organisation”, and the crucial element is to be the inclusion of primary care practitioners and social care within a single governance system. I believe that the Foundation Trust, connected to its community through its public membership, can use its organisational scale and experience to lead a significant improvement to the health of its population.

Finally, I believe that a major impediment to achieving change is that boards have been more interested in winning for their organisation rather than winning for their patients. We know that most hospitals will be unable to meet the standards required of them for a consultant-delivered, sevenday service from their existing workforce pool. Yet they continue to try to appoint more consultants, ending up using premium rate staff to fill gaps in rotas, and they try desperately to be self-sufficient of their neighbouring hospitals, who are doing exactly the same. I believe a real solution is to create new joint ventures where workforce can be pooled across organisations, enabling some consolidation of services which will be in patients’ interests. Joint venturing can be a new approach, between organisations and between sectors, where risks and benefits can be shared, and where patients and communities can be the new winners.

Sir David Dalton, Chief Executive, Salford Royal NHS Foundation Trust
@SalfordRoyalNHS

This blog was taken from an article written for the brochure that accompanied Reform’s major health conference on the 2 December 2014.

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