The NHS has made the headlines again with calls that it needs to ‘reform or die’. Lord Darzi’s recent review has highlighted the need for an overhaul in how things are done. Although more funding is always welcome, there is recognition that pumping more money into the service alone won’t deliver the desired results without whole-scale change.
The NHS is stuck in the balance many businesses face – how to innovate and drive improvements when you are busy with constant crisis management and limited resources. The additional challenge for the NHS, which luckily many organisations don’t have to deal with, is that decisions can be life or death. It’s not possible to simply stop what’s being done to implement brand-new ways of working.
The issues for the NHS were also exacerbated by the global pandemic, not only dealing with COVID-19 patients but also the strain caused by the lockdown, which disrupted services and increased wait times. The extra pressure exerted by the pandemic created an urgent need to deliver widespread improvement at speed.
You won’t be surprised to learn this isn’t the first time reform has been called for. In 2022, a review was conducted to establish how the NHS could develop a culture of continuous improvement while maintaining focus on the most urgent priorities. Improving patient outcomes was the overarching driver for the review and the subsequent recommendations.
The review encompassed feedback from both the people receiving the service and those who deliver it to provide a rounded view. The review also recognised that although there were urgent issues to address, the requirement was to be able to drive continual rather one-off improvements. Delivering improvement is rarely a one-and-done exercise.
A number of recommendations were identified, which were consolidated into three main actions. They aimed to establish what should be done, how it should be done, and how to create the right culture to allow continuous improvement to thrive. No easy task.
Establish clear priorities by creating a national improvement board to agree on a small number of shared priorities.
Launch a single, shared ‘NHS improvement approach’ to establish best practices and increase productivity.
Create a culture of improvement by establishing a Leadership for Improvement programme, which develops a more standardised approach across the service.
One example of the recommendations in action was the hospital matching platform. The platform was designed to quickly and easily match patients to available operation capacity nationwide. The concept was to bring down waiting times by truly seeing the service as a national one. The platform was initially launched to cover patients needing surgery but has since been rolled out to cover an expanded list of services.
“Despite significant pressure on services, NHS staff have already made incredible progress against our elective recovery plan, and this smart new tool will help us to continue to reduce long waits for patients. It shows, once again, the benefits of having a national health service – NHS staff can now work even more closely with other hospitals across the country to identify capacity and conveniently match patients to available treatment and appointment slots. Technology is already transforming the way we work in the NHS and we will continue to embrace the latest innovations, like this one, to deliver the best possible for care for patients.”
Amanda Pritchard, NHS chief executive
Patients were matched based on a range of criteria, including the urgency of the treatment, how long they had been waiting and their ability to travel. When a patient was matched to more than one available slot, the system also allowed for the patient’s wishes to be taken into account, including how far they were willing to travel. The ‘right to choose’ for patients is in place across the NHS, but this initiative highlighted it to patients and actively sought their views.
“We welcome the expansion of the hospital matching platform and think it will make it even easier for patients and the healthcare professional to make a decision together about where to have treatment or a test. Patient choice has been a right for over decade but not all patients are aware they have the right, and it isn’t always offered to them. Hopefully, making it easy for health professionals to easily see the choices of where patients can be treated will increase the number of patients who can take advantage of mutual aid within the NHS.”
Chief executive of the Patients Association, Rachel Power
In this example, using data and adopting technology had a large impact. What may have surprised you is that this process wasn’t already in place. Lack of funding and the slow pace of digitisation across the service has taken its toll. Unfortunately, like for many businesses, working in distinct departments and geographical silos has also been a blocker to communication and collaboration.
There are other examples of pockets of improvement seen in the NHS.
Alder Hey Children’s NHS Foundation Trust
Patient experience scores went from 59% in 2020 to 92% in August 2022.
University Hospitals Sussex NHS Foundation Trust
Transitioned from ‘Quality/Financial Special Measures’ to ‘Outstanding’ in 2019, with high ‘buy in’ from staff specifically noted.
The Leeds Teaching Hospitals NHS Trust
Improved rating from ‘requires improvement’ to ‘Good’ and transitioned from a £100m deficit to a £19m surplus.
These changes on a smaller scale are impressive but aren’t enough to reform the whole service. Large-scale changes across the board are needed to bring the NHS up to a standard people are desperate for it to achieve. Whatever comes next, there will always be a need for continuous improvement to keep the service evolving and fit for purpose.
We would love it if you could share your story of innovation and improvement with us. Has this story inspired you to share yours?
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