Sometimes if things are to change, the whole system needs to be rebuilt. As Michelle Obama said recently, don’t reach for normal, reach for better. So how can we do that in the NHS?
The incredible pace of change we’ve seen within the healthcare system in 2020 has proved what’s possible in a crisis. But if the right change is to be embedded and more changes are to be made outside of this context, what infrastructure is needed?
In the reporting of the Government’s Obesity Strategy news outlets seized on the idea of prescribing cycling. Ministers promised that local cycling infrastructure would be improved. It’s easy to see what needs to happen to make that work – cycle lanes, storage and low-traffic neighbourhoods are highlighted.
So what infrastructure changes are needed for the NHS to make the necessary changes brought into focus by Covid-19? What’s the NHS equivalent of cycle lanes?
Creating the conditions for change
Our previous blog highlighted the need to build in the patient voice to any new NHS changes. It also discussed the need for a shift in attitudes about what the NHS is for – is it to treat illness or facilitate wellbeing?
One of the structural changes needed to enable patients to take ownership of their health and wellbeing is for clinicians and healthcare professionals to reframe their role. With an increase in the need for self-management and care, doctors and nurses need to be confident their role is to facilitate patients owning their health, not undermine attempts to do that.
Much more will need to change to make this a reality. For a patient to monitor their own blood pressure they’ll need equipment, perhaps training, and certainly confidence to do so. How can the voluntary sector shift their focus to enable this kind of change? What needs to change in the training of our healthcare professionals to limit the perpetuation of this dependency?
What technology is needed? How can the health service make use of apps or other digital platforms to empower patients to own their health and wellbeing? What do we need to do to help patients understand their body and how to manage it?
The NHS cycle-lane equivalents
We need to create the right infrastructure to support and sustain the right change. It’s the NHS equivalents of the cycle lanes, storage and car-free routes that will be needed to encourage a nation to get on their bikes. What does that look like?
Clinical care models are part of the infrastructure. They have been forced to shift during the pandemic; previous resistance swept away in the face of a new imperative. Clinical leaders have had no choice but to develop and adapt settings and care pathways, and to engage their teams in the changes. Face to face consultation is no longer the default setting. New procedures of assessment and escalation have been produced in double-quick time. The question is, what should remain once the current crisis settles down to a dull roar?
Enabling this, board skills are a critical piece of infrastructure that scaffolds change. Without the right skills, confidence or information boards can become pinch-points that frustrate, rather than facilitate change. What input do boards and board members need to be able to properly assess risk, to stay strategic and to seek the right assurance about the changes being made?
We have more questions than answers. But if ever there was a moment to do things differently, to reach for better, to create the NHS’s cycle lanes so that the right change sticks, it’s now.
Linda Prosser is a Senior Associate at thevaluecircle and a former NHS Chief Executive Officer. She dreams about health integration at scale.