Going through the change

I’ve worked in the NHS for thirty years now, and occasionally get asked “but….why?” in a tone of voice that appears to question my sanity. The answer is quite simple – change.

Let me explain. There’s a popular (and, in my opinion, damaging) narrative developing in certain quarters. The nuances vary, but the gist is that the NHS is essentially the same as it was back in 1948. That the structure has atrophied, like a fly-in-amber time capsule from post-war Britain. The inevitable implication is that the NHS isn’t fit for purpose.

Nothing could be further from the truth. In the past few years, we’ve seen Sustainability and Transformation Partnerships; a Five Year Forward View; a Long Term Plan and a new Health and Social Care act. All of them brought sweeping changes – sometimes coming so thick and fast it’s felt like an arcane game of Tetris.

Whatever the NHS’s problems are, structural stagnation isn’t one of them, and it is most definitely fit for purpose. But I do think it’s fair to look at how we handle change, both at a national level and an organisational one.

Change comes in many flavours – structural, technological, process, behavioural, social and cultural to name just a few. Too often, I see a focus on structural, process or technological, with the others deemed “someone else’s problem”. But trying to pile a structural or technological change on top of static behaviours and culture is a bit like trying to ice a cake whilst it’s hot from the oven – things tend to slide off.

We need to start thinking about change differently – as a package, and with humility, honesty, and a willingness to listen to others.

The American journalist Sydney J Harris once said: “Our dilemma is that we hate change and love it at the same time; what we really want is for things to remain the same but get better.”

For example, most of us who work in NHS finance have known for many years that a lack of consistency in the back office causes inefficiencies. Our new Integrated Single Financial Environment will help reduce this. For the first time ever, we’re implementing a single service to be used by NHS England, all commissioning organisations and trusts.

There are significant benefits to this type of unified service – the cost savings for Trusts alone are sizeable. We’ve been working on this for a while and have realised the main challenge isn’t a technological or a process one – it’s a cultural and behavioural one. A recent meeting of senior finance representatives from every ICS agreed that the direction of travel is right, which is a huge step forward. Now, it’s time to encourage that seed of consensus to take root, so that the direction of travel can become a reality. But this can only happen with that mindset of humility and honesty.

In that spirit, I’d like to encourage conversation. How do you nurture change in your organisation? What challenges have you experienced? How did you overcome them? What’s worked well? What needed to improve? How could other organisations learn from your experience? How have you countered unhelpful narratives (like the one I described at the beginning of this article)?

One NHS Finance have started a crowdsourced conversation, which I’d encourage everyone in the finance community to contribute to. It provides a superb forum for collaborative development, and I genuinely believe it could help shape the future of NHS finance.

The NHS is no stranger to change – quite the opposite. But there’s a long way between familiarity and expertise. Let’s talk about how we get there.