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Alice Donovan-Hart Director of Consulting, NHS Shared Business Services |
The UK Government’s ambition to modernise the NHS and make it more efficient, digital and patient centric must be driven in partnership with the people within the NHS, not solely by political think tanks and change consultants.
Highlights
- NHS 2.0 is the complete redesign of what people do and how they do it
- Frontline staff will need the best tools, processes and back-office support possible to deliver the vision of NHS 2.0 — at a time when spending on corporate functions faces stringent cuts
- There is a disconnect in the discourse between what corporate services currently deliver and what frontline teams need
- NHS organisations must act fast to deliver major savings, while ensuring continued corporate services delivery to frontline staff
- NHS 2.0 will move the NHS to a place where experts in corporate functions are freed up to do what they do best
- Our NHS 2.0 vision begins close to home by looking through a ‘people lens’
Re-thinking how the NHS works
The National Health Service is in the midst of massive upheaval. Funding and how it is shaped is a burning platform for NHS leaders amidst ongoing global geopolitical uncertainty, from which the NHS cannot shield itself in terms of government budgetary decisions and the impact on healthcare supply chains. Tasked by NHS England’s new transition chief executive Sir Jim Mackey to slash the cost of their corporate functions, England’s 215 trusts must re-think how they work and how they use technology.
Here, I explore the implications of this on both the running of the NHS and on the ability of its professionals to deliver healthcare excellence.
NHS 2.0 — a new vision for the NHS
As government strategy for public healthcare shifts the focus from ‘diagnose and treat’ to ‘predict and prevent’, a core component of this will be data — how it is captured, analysed and used to best effect. So, what will a data-driven, digitally powered future NHS look like? I believe it demands a new vision — one that NHS Shared Business Services calls NHS 2.0.
This vision is built on a bedrock of corporate services and enabling technology that utilises accurate and relevant data. But what exactly is it?
With NHS 2.0, NHS SBS envisions the complete redesign of what people do and how they do it. This aims to empower the NHS to dynamically shift from analogue to digital, at pace. It is never going to be a ‘start all over again’ position, however; rather, it’s about working with what’s already there and evolving to something new and better.
So, while digital transformation and huge infrastructure projects are (slowly) building a better public healthcare system, our vision begins closer to home by looking through a people lens. It’s about ‘getting the basics right’ — the back-office processes, recruitment & retention, finance operations, technology, etc. without which effective and efficient frontline care delivery couldn’t happen.
Addressing shared challenges
The NHS is not alone in its need to change fast. There’s a familiar tale being told across both the public and private sectors. Organisations are grappling with heightened customer/citizen and employee expectations, a growing and ageing population, and escalating resourcing issues. There’s also the need to integrate legacy and digital systems, to manage (or not) budgets under huge pressure, and to innovate with new tech, including AI and machine learning.
Many are well ahead on this journey, especially the private sector and some trailblazing public sector organisations. But here’s the rub: The NHS is one of the biggest employers in the world. Its annual budget stands at around £179 billion. It employs upward of 1.5 million people. Turning around the vast and unwieldly NHS ship is going to need brave decisions — and many of those will be taken at a micro level by individual NHS trusts and integrated care systems (ICSs).
NHS 2.0 — putting (your) people at the heart of change
So, if you’re on board a ship that’s sprung a leak in the middle of the ocean, who are you going to call? A land-based team with grandiose ideas, but little practical experience of bringing them to fruition? Or the onboard crew members used to the ebb and flow of life at sea and with an understanding of how their particular vessel operates? No need for answers on a postcard.
Is this too simplistic an analogy for a huge and complex challenge? I don’t think so. That’s because successful change must draw on the knowledge and experience of people already within the system; professionals who know what’s working well — and what isn’t.
At its heart, the requirement to deliver both the government’s agenda and the healthcare that everyone needs rests on the very people delivering that care — the frontline teams in hospitals, surgeries, and in the community. While they might not be making the tough decisions on what to cut in the first place, they will be at the forefront of implementing the changes that deliver the spending and efficiency measures being demanded of the NHS. In other words, they will be responsible for delivering the future vision for public healthcare.
Crucially, they will need the best tools, processes and back-office support possible to deliver that vision — at a time when spending on corporate services faces stringent cuts. Without this, morale (already very low) will dwindle still further, with implications for costs, efficiency and, of course, the patient experience.
How will NHS 2.0 impact frontline care?
What do we mean when we say we need to look at this challenge through a ‘people lens’? Imagine you are a doctor or nurse who has got to the end of a long shift, exhausted and fed up with tech that hadn’t hit the mark, blood results that didn’t arrive in time, lifts between floors that failed to work, an over-heating boiler system, and an under-resourced department. Then when your salary lands you discover an error — you’ve been underpaid. Each one on its own might seem inconsequential, but it’s the little things that add up.
This scenario reflects one of the most powerful sentiments expressed in Lord Darzi’s report on the NHS, which notes that “Instead of putting their time and talents into achieving better outcomes for patients, clinicians’ efforts are wasted on solving process problems.”
Our NHS 2.0 vision focuses on building happier workplaces where morale is high because people feel supported by corporate functions like payroll, procurement and finance, and enabled by both technology and modern processes.
Bridging the disconnect for a happier workplace
Currently, however, this vision needs some work. There is disconnect in the discourse between what corporate services currently deliver and what frontline teams need. To build happier workplaces, this disconnect must be fixed.
Our NHS 2.0 vision sees the NHS moving to a place where experts in corporate functions are freed up to do what they do best. For example, qualified financial controllers will be in a better position to advise the board and model good financial practices for the wider organisation, rather than being bogged down in number crunching. Skilled HR teams can deliver more engaging services and guide recruitment strategy when more mundane, repetitive tasks are undertaken by digital technology and automation. Commercial teams will have the data they need to derive maximum impact from investments designed to improve both the workplace and patient care.
Accelerating on the road to NHS 2.0
With the government imperative to cut the cost of corporate functions, NHS trusts and ICSs must accelerate their journey towards leaner, more efficient and cost-effective public healthcare provision today. As a starting point, the geography and history of the entire system (whether that system is a trust or a broader ICS) must be looked at, not just elements of that system. What needs to be done to help people work differently? How can different teams and locations be brought together to share best practices or create efficiencies?
NHS leaders should be cognizant of where their systems are starting out from and agree on a joint vision that all parties buy in to. Of course, it’s not going to be easy if different parts of a system haven’t worked together before — perhaps different clinical divisions within a hospital, separate hospitals in a large trust, or various care providers forming an ICS. When you are immersed in a system it can be tough to make difficult decisions about teams you know well. That’s where a national system of standards, automation and processes is useful, which is what our model for NHS 2.0 rests on.
A national system in a devolved landscape…
Advocating a ‘national system’ when the Health Secretary has urged a ‘triple devolution’ of power from central government to local systems may seem odd, but bear with us. With 42 integrated care systems and 215 trusts expected to save money in corporate services, there’s a case to be made for standardisation and shared learning in terms of the tasks that all NHS organisations undertake — that’s what we mean by a ‘national system’ in this context.
New ways of working and innovative technologies already proven in one part of the NHS can (and should) be shared as standard practice with other parts — what the Health Secretary describes as “taking the best of the NHS to the rest”. The removal of roadblocks to effective recruitment and retention in one trust can be replicated in others. Streamlined processes and automation that have freed up time for finance and HR teams to focus on more strategic work across an ICS have the potential to be introduced elsewhere.
The efficiencies created would unlock major cash savings that directly fuel investment plans, helping the NHS do more with less and deliver greater impact.
…but no one size fits all
Crucially, while we advocate such standardisation, we also recognise that no one size fits all. What works in urban centres like London or Manchester is unlikely to work in rural communities, such as Devon or Cornwall, so these standardised practices and technology enablers have to be tailored to each participating organisation. Through shared learning about new ways of working, process optimisation and enabling technologies, NHS systems will see measurable impact much faster than if they go it alone.
A quick word on automation and AI
Of course, new and emerging technologies will be part of this journey. Quite rightly, artificial intelligence (AI) is much vaunted as an enabler of faster and more accurate diagnosis, reduced human error, lower costs, and much more. Yet, as the NHS continues to work on the trustworthiness and governance of future AI solutions, we argue that it is important to walk before you run!
Smart automation within corporate functions is a cost-effective starting point. Built on standardised processes, robotic process automation (RPA) reduces costs, enhances productivity with streamlined operations and improves decision making. Looking to the future, AI tools will be implemented on top of this solid foundation of RPA to deliver scalable solutions that improve service delivery to frontline professionals and drive sustainable change.
Conclusion — Get the basics right and the rest will follow
Corporate services are the bedrock of efficient and effective frontline care. They create happy, productive workplaces and ensure healthcare professionals feel valued and supported. Now, however, with swingeing cuts to spending on corporate functions in the pipeline, NHS organisations must act fast to deliver major savings, while ensuring continued service delivery to the thousands of people at the forefront of patient care.
At NHS Shared Business Services, we believe that this begins with getting the basics right — the HR, finance, and procurement activities, all enabled and transformed by automation and technology. This is a central pillar of our NHS 2.0 vision. Highly qualified back-office teams should be freed up to focus on more strategic, value-adding activities, while shared best practices and standardisation enable cost efficiency and resource optimisation.
That’s why, in our role as a member of the NHS family, we put the learnings, value and innovation from the NHS back into the NHS. The result? Local trusts and ICSs that can learn and benefit from each other. In the future, this will enable them to save costs, power innovation and look after NHS people and the patients they care for in a world that we envision as NHS 2.0.
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