What steps should we take to create a more conducive culture in health and care?

People committed to improving health and care spend much of their time talking about NHS structures, finances and governance and not enough time talking about organisational culture. In this year’s Summit, we’re going to redress this balance.

The problem is that the word “culture” is so vague. When I’m speaking to clinicians and managers in my local NHS acute trust where I’m a non-executive, I use a more colloquial phrase. “Tell me the views of you and your colleagues about how things are done around here?” I ask. The response is enlightening.

What I hear back

Some people tell me about the high level of commitment and mutual support, the focus on helping colleagues to do their best and the emphasis on collaboration. Some talk about how forward-looking, innovative and entrepreneurial their teams are. Others describe the drive and goal orientation of their colleagues.

And all of them talk about how the long-established values and sense of pride in their work and their institution comes a distant second to the more hierarchical culture of the wider NHS. They describe a culture where the emphasis is less on enabling and more on monitoring and controlling, less on trusting professionals to do the right thing and more on checking what they’re doing.

Some people I speak to are disillusioned and some angry about the disconnect between the working environment they are trying to nurture on the ground and the political, with a small p, environment they are operating in.

But most understand why we are where we are. They can see the environment that politicians and NHS leaders operate in and the imperatives that drive them. They understand the need for services to be more responsive to the needs and expectations of patients, for professionals to be more accountable and more transparent, and the drive for greater efficiency. They know that targets and financial incentives can be powerful drivers of change, though they are also acutely aware of the unintended consequences of performance management levers, and they know how to game them.

There isn’t such a thing as a perfect culture that the NHS should be aiming for, but we do need a more thoughtful balance between controlling cultures and collaborative, creative and competitive ones.

So here’s my challenge to those participating in the Summit: what steps do we need to take to create a cultural shift?

Exciting and busy programme ahead

I’m confident that the programme over the next couple of days, with its combination of keynotes, panel sessions and downtime, will help you reflect on this question. We kick off with our new chief executive, Thea Stein, challenging the rhetoric of ‘productivity’. Thea took over from Nigel Edwards six months ago and under her leadership the Nuffield Trust hasn’t missed a beat in delivering its mission to generate robust debate and solutions based on the best possible research, evidence and analysis.

After Thea’s session we’re delighted to welcome the Secretary of State for Health and Social Care, the Right Honourable Victoria Atkins MP, to present the government’s vision for dealing with the challenges facing the NHS and care systems.

The first panel session will explore the role of AI in transforming patient care and administrative systems. That will be followed by a keynote delivered by one of the most inspiring and courageous medical leaders that I’ve had the pleasure to work with, Professor Sir Chris Whitty, who will consider emerging patterns of disease in older adults. The next two panel sessions on Day 1 will explore how we tackle health care inequalities and new approaches to managing clinical risks in health care.

Day 2 will start with a breakfast session on how technology is changing the relationships between clinicians and patients. The first panel session will explore the importance of trust, particularly in managing complexity and uncertainty, and last, but certainly not least, the final panel session will turn to the workforce and explore the shifting expectations about work and their impact on recruitment and retention, in particular on the next generation of health care workers.

So, a busy couple of days but plenty of time we hope for informal conversations too.

Thank you

The Board and staff of the Nuffield Trust are so grateful to you for making the time to contribute to our 2024 Summit. The scale of the challenges facing the health and care system in the UK, and in most other countries, have never been greater and the sense of crisis is real. But we have firm foundations on which to build a better health and care system, in particular the remarkable commitment and professionalism of the workforce and a high level of public support for the NHS.

Whether you join in person or follow the live-stream on our website, I hope you enjoy the Summit and are inspired with new energy to lead change.

The Nuffield Trust Summit takes place on Thursday and Friday this week (March 7-8). You can register to watch the live-streamed sessions. More information about the event can be found here.