NHS Reset: Is there no going back for the NHS? | Katy Saunders

Katy Saunders

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Katy Saunders argues we have an opportunity to redesign healthcare and the focus, flexibility and collaboration shown by the NHS puts us in a good place to do that.

My experience of outcome-focused healthcare suggests that we don’t have to go back.

We don’t have to go back to a well-intended system that caused unintended harm: 

  • a system designed to ensure accountability but where you start preparing for the next performance meeting as soon as the last ended
  • a system that aspires to integration but where colleagues meet most regularly in escalation panels
  • a system that often starts with the problem rather than with the people and what they value.

I joined Social Finance in 2019 with 11 years’ experience of healthcare service innovation. I’ve held several senior roles in the NHS and the third sector. I’m committed to different ways of commissioning and delivering services. Enabling new partnerships between the NHS and charities. I am staggered by the striking similarities between the system’s response to COVID-19 and the best projects that I’ve been involved in at Social Finance. A combination of focus, flexibility and collaboration.

We now have a time-limited opportunity to redesign healthcare.

"We’ve been able to achieve things we’ve been talking about for years… we can’t go back to how things were." 
Health charity chief executive

A focus on people first

Social investment partnerships focus on outcomes that matter to people. Working with socially motivated investors, like health charities, we have helped develop new end of life services with a focus on enabling people to die in their place of choice. Keeping it simple is hard. Across the NHS, COVID-19 has provided a temporary focal point for all and simplified workflows and load. This has come at a cost with the suspension of many critical services, such as cancer treatment. But some things have stopped that don’t add value for people – like the complexity which has accompanied many discharge processes. Having a clear focus is powerful, and it can’t be lost as we return to a new normal. People should be encouraged to ask questions like: “Is this work contributing to outcomes that matter?” and: “Is this process helping me to do my job?” Ensuring charities have a leadership role within integrated care systems (ICSs) will help to hold this mirror up. Regulators also need to be prepared to listen with open ears to feedback from their workforce.

Just do what you need to do

Social investment, with a focus on outcomes, can also help drive the flexibility that we have seen in response to COVID-19. Clinicians, operational managers and commissioners review data regularly to make real-time changes. Without lengthy governance processes, and with the reassurance of a secure financial envelope, services and commissioners can work together to proactively respond to trends. This in turn encourages creativity and innovation. Partnerships between the NHS and charities have benefitted from this flexible approach. ICSs should harness this natural resourcefulness as well as people’s willingness to ‘work outside the lines.’

No more zero sum

A key factor of social investment is to identify joint incentives for all stakeholders. We work to create an interdependent relationship between commissioners, providers and patients. Cooperation drives a positive-sum gain. Right now, there is an overwhelming sense of unity and common purpose. This in part is being driven by a ‘Blitz Spirit,’ but lots of people I’ve spoken to also attribute it to the pausing of contract monitoring that focuses on the counting of activity. This disincentivises joint working and is antagonistic. It can also freeze out and/or alienate smaller providers, such as charities. It is important that ICSs are governed by processes and systems that encourage interpersonal rather than transactional relationships.

Is there really no going back for the NHS?

I would like to think not. However, I have a niggling sense that with the looming financial crisis it will be all too easy to revert to command and control. I really hope I’m wrong….

Social investment partnerships aren’t the only way to focus on the outcomes which matter most to people, enable flexibility and incentive genuine collaboration. I’ve seen the best of that within the NHS and third sector. But my experience over the last year at Social Finance has already convinced me that this can be the norm. The best of the COVID-19 response demonstrates that in abundance.

We need to step out of our old comfort zones and embrace cultures of engagement along with approaches of accountability and funding which sustain that. We need NOT go back.

Katy Saunders is associate director of Social Finance. Follow them on Twitter @socfinuk

Get involved in the NHS Reset campaign 



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