Professor Nick Rich argues that ambitious, long-term ideas are needed to help to make the NHS fit for the future
For several years, the Bevan Commission (Wales’ leading health and care think tank) has been supporting NHS professionals – called Bevan Exemplars – to trial and test out innovative ideas in their own health and care settings, from hospitals to care homes. I have been evaluating the scheme’s progress, which has demonstrated consistent success, especially when compared to health and care innovation in other countries.
This year is no different in terms of the headline findings: a 75% success rate for Bevan Exemplar projects and a slew of positive outcomes in terms of patient experience, health improvements and resource efficiency. But there is one key difference to this year’s cohort of NHS innovators: their notable emphasis on ‘big picture’ transformation.
Transformation from within
In previous decades, a culture of “managerialism” dominated the NHS and healthcare managers looked to other sectors for best practice that they could blindly emulate. This era has ended with the growing realisation that the enduring solutions needed for a modern NHS could and should originate from the ideas of their own staff. Such staff must be armed with the necessary leadership and improvement skills, and the confidence to challenge current wisdom and generate innovations so that they truly have ownership of the solutions to their problems.
The illogical rationale of imposing someone else’s solutions to similar-looking problems has proven ineffective and healthcare organisations have returned to the fundamentals of improvement and innovation: identify a reason to change, identify the root cause of the issue and engage in experiments (with reviews to see whether improvement has happened) – then to learn from this experience to find the next transformation in care provision needed.
This learning cycle is embedded into the design of the Bevan Exemplar programme, which includes projects such as:
- Paramedics working with GPs in local surgeries to improve response time and deliver care at the point of need.
- An AI (artificial intelligence) chat service which can answer questions about health conditions and signpost resources for patients.
- Creating a new specialist role to enable cancer patients to access radiotherapy services more easily.
- Upskilling care home staff to provide basic health treatments (such as wound care) in-house.
Learning to see the ‘big picture’
Many of these projects are not ‘quick wins’ with an immediate pay-out for the NHS in terms of resource efficiency. In fact, many of the projects I evaluated were long-term and ambitious in scale – seeking to address NHS structures and processes wholesale, rather than a small, measurable improvement or local challenge.
Although these sorts of projects do not generate headline-grabbing figures in terms of return on investment, they could provide sustainable solutions to some of the health and care system’s most pressing challenges. With an ageing population and a NHS recruitment crisis on our hands, we need ‘big picture’ thinkers and risk takers.
Supporting innovation projects which have an intent to be transformative, rather than merely improving, requires courage from the NHS. For example, investing in a digital widget which is proven to save primary care staff time when processing patients is an attractive investment. Challenging the digital infrastructure from the bottom up, or even rethinking the way we admit and process patients and who does this work, is much more risky and less immediately beneficial for the NHS. But it is this sort of innovation – and the frontline NHS professionals willing to put their heads above the parapet to lead it – that the health and care system desperately requires.
Annuities, not quick wins
My recommendation for the Bevan Exemplar programme of health and care innovation is to continue investing in long-term, ‘big picture’ objectives but to provide health and care professionals with more time to test these ideas out in the real world – my evaluation found that many Exemplars needed to test their project, adapt it and test it again after an initial stage of learning.
I hope that this Welsh model of slow-burn, transformative innovation influences other health and care systems across the UK and the rest of the world. All health and care systems need to invest in their staff and provide them with the leadership skills they need to generate their own solutions to the big challenges. If they do make this investment, they will develop an annuity of benefits for patients across an individual’s entire career, rather than a quick win in the short-term.
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