Policy matters: the reality of NHS change

This is a bewildering time to be a patient or a carer in the NHS. For five months I have been into an acute trust almost daily. I’ve walked past picket lines of junior doctors and talked to them about their plans to quit the NHS.

I see headlines about unstoppable deficits, despairing GPs, overworked nurses, and as I watch the endless drift of people in the hospital corridors – the ill, the well, the worried, the bereaved – I wonder what the impact of all of this has been on those needing care. Are they more afraid? More stressed? Are they full of despair too?

Would knowledge of all the policy activity behind the scenes – the Five Year Forward View, Sustainability and Transformation Plans, the New Models, MCPs, PACS and other Vanguards, the fact that there are plans, there are resources – reassure anyone in the teeming hospital corridors? For most people, I imagine, all this would represent unfathomably distant bureaucracy: the quality of their daily experience depends entirely on the quality of their daily interactions with staff. If the staff are calm – and they are always magnificently calm in our small corner of the NHS – then everything must be alright.

A focus on staff is at the heart of our annual Health Policy Summit, which kicks off on 3 March 2016. The massive NHS workforce will have to change to survive. We need a workforce that has the skills and knowledge to meet ever-evolving patient needs, at the same time as working within shrinking budgets and workforce shortages. These themes will be explored in a series of sessions: Dr Hilary Cass will set out the challenges of improving care to children, arguing that there has to be more specialist paediatric skills in primary care, and that hospitals must better understand community needs for children and their families.

Professor Martin Roland will reflect on how primary care can use a broader range of staff and skills to offset the growing strain on GPs and their colleagues that’s becoming all too visible to patients. Just how much mileage there might be in training up existing workers, adding new skills and designing entirely new roles will be explored by our Director of Policy Candace Imison. At the heart of successful change lie strong relationships between doctors and managers: Professor Huw Davies will talk about how these dynamics have changed over the past decade from his recent research. No change can happen if relations are bad.

No change can happen without improved IT either. But the NHS workforce have often had very poor experiences with new IT projects, adding complexity and stress into already complex and stressful working lives. The Summit will hear from Bob Wachter about his experience of introducing digital health technologies in the US. New technologies cannot just be layered on top of existing work patterns: the work itself needs to be reimagined in order to release productivity.

This reimagining has to be closely informed by the staff already doing the day job. And there’s the rub: the NHS workforce have to do more than just their day jobs. The sort of transformation envisaged in the Five Year Forward View needs all staff to be contributing to the myriad of constant improvement projects, at the same time as finding efficiencies, at the same time as delivering against targets to satisfy the battalions of regulators, at the same time as being compassionate in their day-to-day encounters with patients, and to whom they must, of course, deliver the highest quality care possible.

It’s a tough ask, particularly for those at the forefront of innovation. The Summit will hear from those designing and implementing new models across England, and from those overseeing it: Simon Stevens will reflect on how the first 18 months of NHS England's Five Year plan have gone, and what hopes he has for the remaining three-and-a-half years.

The Summit will also provide our delegates with an opportunity to step back from the detail and look through a much bigger lens. Mark Britnell will be giving his insights from his analysis of the best that the world has to offer: in search of perfection, in innovation, in delivery, funding and patient empowerment.

But the pursuit of global perfection will stand in sharp contrast to the reality facing the users of public services in the UK. Will Hutton will explore the logic of the shrinking state in Britain, and what it means for services that people have come to depend on. And the implications of that will perhaps be the most disquieting for the patients, the families, and the carers around me in the hospital corridors.

Just what sort of role will they have to play to sustain the NHS in a shrinking state? And when will anyone tell them that they might one day have to pay more, either with their time, their patience or their taxes?

The Nuffield Trust health policy summit will take place on the 3-4 March. You will be able to livestream the full event from our summit microsite or follow on Twitter with #NTsummit.