It's a huge question, a really really big question and not one that can be immediately answered. But some of the elements of what will need to change are becoming clearer, and in an effort to understand them we were lucky enough to spend some time with Mark Friedman, an experienced recovery director in the NHS. We asked Mark four key questions to help us understand where the NHS is today and what the challenges are going to be going forward. In a long and fascinating conversation, we captured these thoughts which we share here.
"Firstly, I am full admiration for what has been achieved, and praise for all that the staff have done to protect and heal our citizens. "
1. How do you see the NHS today?
- In terms of how I see the NHS from a management perspective it could be characterised as being in an anarchic phase with a loss of some local controls albeit where rudimentary governance is still being maintained.
- Heath Robinson solutions, some brilliant and innovative, others clearly Elastoplast, have been bought in, and it will be a management challenge to spot what is working and embed it, whilst removing those that don't deliver.
- I think there is still uncertainty about what recovery really means and what needs to change to deliver a next normal service (and where the priorities sit e.g. flow, revenue spend to bolster workforce to match capital investment and recovery around financial grip/control).
2. What do you think about the demand / capacity imbalance?
- It is clear that the backlog is there and is growing every day, and sicker patients, who have delayed presenting, will further increase the imbalance.
- It is also clear the NHS will have reduced capacity for the foreseeable future due to changes to working practices and untenable assumptions or numerous sensitivities relating to pandemic ebbs and flows.
- Exhausted staff cannot be exhorted to work harder, so the big driver of change in the NHS going forward will be the need to dramatically increase and reposition capacity and skillsets cost efficiently.
"In short, a lot will have to change!"
3. What will change?
I can think of many things immediately that the leadership will need to look at, including:
- The current access ethos will change, even if unpopular, patient choice cannot be the same as before due to operational restrictions caused by the virus.
- Capacity thinking will be required to properly understand demand and supply and system-wide management will be implemented, causing many traditional boundaries to fall.
- Digital learning will be embedded, and funding should reflect this as a key priority at scale and pace.
- Clinical practice will continuously evolve as digital techniques are tried and implemented where successful.
- The public / private relationship has to be different as well. Private has been ‘co-opted’ for the short term, but forms part of the solution in many areas, and whilst this may cause concern amongst many it is probably the only way to provide satisfactory care.
- A new financial model will have to be created reflecting new models of care, patient journeys and commissioning structures, this alone will be a huge task.
- The biggest change may well be in the culture of the NHS as they have to become more flexible, adaptable and innovative. They may also need to accept a greater level of risk to ensure that all patients requiring treatment receive the care they need.
4. What does this mean for data & analytics?
- Capacity & demand analytics are going to become crucial, there will be swings in activity such that the need to understand what is really happening, and to provide information for decision making will grow rapidly.
- Prediction as an aid to decision making MUST take over, the old fashioned "rear view mirror" reporting does not help navigate in an uncertain environment
- Analytics will have to expand to have a system-wide view and not be stuck in individual silos, this is a big ask, but it needs to be tackled
- There is much the NHS can learn from the commercial world when it comes to data and analytics and there needs to be a greater emphasis on developing talent through coaching and development.
This snapshot of what is going to change could help us understand the challenges the NHS will face and provides a great perspective from a seasoned NHS executive. We hope this short summary prompted some useful thoughts for you, and we would love to hear your feedback.