Capturing the lightbulb moment before it flickers out | Danny Mortimer

Danny Mortimer

Lightbulb moments represent a breakthrough in new thinking, a moment of clarity or a sudden realisation. We have experienced months of bulbs flashing all across the NHS.
But these are not just warning signs of what cannot be achieved due to the immense pressures of COVID-19, they have been moments of inspiration and innovation from members about the opportunities that can be realised.
Transformation has been a buzzword readily deployed for years but we often forget the impact regulatory architecture can have on this process. It is difficult to envisage new ways of working when the existing ones are the practised orthodoxy and with health rightly being a safety critical industry there is understandable angst at recalibrating what is familiar.
Of the things that enabled you to provide the best care you could during the pandemic, one of the consistent reflections identified the welcome light touch regulation and oversight from national bodies, including the CQC’s decision to pause inspections and the retrenchment of NHS England/Improvement performance management.
Now we are looking towards the future and how health and care should function, it has given us all a fresh perspective on what regulatory architecture we need in place. We have been listening to your views and experiences and this week we published a new report and wrote to the Secretary of State to encourage him to follow through on his bureaucracy busting vision and move forwards with systems regulation, empower health leaders and reduce duplication. Our message to him – and other national leaders – is that they need to own the role they play in generating the present cumbersome, duplicative, and opaque system of regulation and performance management.
The message we have been hearing from you is of course not an end to regulation and oversight. Far from it. Safety is paramount but regulation and performance management that is disproportionate stifles innovation and provides the illusion of assurance and actually gets in the way of safe and effective care for you and your teams. There is a need instead for regulation which allows you to focus on looking after people rather than paperwork, patients rather than proformas.
You have also told us that we need regulation that reinforces whole system working, and looks at the patient pathway more and does not look at organisations in isolation, to reinforce the integration that we have seen during COVID-19. You have also told us of your concern that too many colleagues in the Arm's Length Bodies are returning to the old way of working and have not reflected on what they can now do differently.
The report and letter are very much therefore the start of a process and call to action, with the next step being the Health Secretary’s bureaucracy review, which we will contribute to based on your views. We have also asked him to meet a selection of members to hear your experiences directly.
Looking forward, I’m clear that the issues raised in our NHS Reset work about regulation and oversight will be an ongoing priority for the NHS Confederation. We will bring together different parts of our membership to collaborate on the design of a leaner, lighter and more agile regulatory architecture for the NHS.
COVID-19 has convinced many of us of the need to address health inequalities, to accelerate partnership and whole system working, and to continue to innovate. We can’t do that and return to the outmoded industrial scale regulation and oversight of the past.  

Tell us more

We would be grateful for you views as we continue the process to influence change. That goes for the wider conversations about what the health and care system should look like in the aftermath of COVID-19, which has been the focus of our NHS Reset campaign. We are seeking views in our latest member survey. We will publish the findings in a major report in late September, which will be the final report from our NHS Reset campaign and will set out the views of you, our members, on the future of the health and care system. 
NHS Employers, which is part of the NHS Confederation, is also seeking you views on the consultants’ reward scheme. We have an opportunity to work with the doctors’ unions to redesign the consultants’ reward scheme and our aim is to agree a lasting and sustainable system using the £160 million available nationally every year, which is based on a set of agreed principles, meets the needs of employers and consultants, and encourages engagement and rewards excellence. You can find out more here.

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