COMMENT
NHS improvement The future for
The way the NHS handles improvement is changing. NHE spoke to Jim Easton, the National Director for Transformation on the NHS Commissioning Board, and an architect of QIPP.
A
t one NHS Confederation conference not so long ago, Jim Easton recalls, six
different exhibitors had the words ‘NHS’ and ‘improvement’ in their titles – but that landscape is now changing, as he told the 2012 conference.
Speaking to NHE soon after the conference, he said the improvement function in the NHS will be streamlined into a smaller body, with a tighter focus and more emphasis on working with partners in the deliver of change-support products and solutions.
He told us: “We’re taking the opportunity to think about the best shape for the support people need in tackling the tremendous challenges that face us in driving quality and productivity.
“The good news is we have a really strong inheritance: bodies like the NHS Institute, which has some fantastic achievements like the Productive Series. There is a long and slightly hidden history of it developing many thousands of NHS leaders and clinical leaders with improvement skills. At most organisations, leaders and frontline staff will talk routinely about ‘lean’ or ‘redesign’, and all that has come from that work. It’s inherent in organisations like NHS Improvement, who’ve got that fantastic work on leading frontline clinical change.
“But there are also things we want to change; there’s a new group of leaders in CCGs on the pitch, with new demands. It’s fair to say there’s a desire for more customer focus in delivering what frontline organisations need. So, if you talk to foundation trust chief executives, some are fantastic advocates of the work they’ve been doing, but others less so, and they feel maybe it doesn’t meet their frontline needs in delivering their care.”
‘Root-and-branch redesign’
Ever since the review of NHS arm’s-length bodies soon after the Coalition came to power, it has been clear that change is coming. Easton said: “We’re going to take the chance to take those improvement bodies and work with them to do a root-and-branch redesign: protecting
14 | national health executive Jul/Aug 12
what they’ve got that is fantastic for the future, but also being unafraid to completely change them and develop new areas in terms of frontline support.
“For those people leading organisations, departments or teams, what is it they think we should protect – and what should change? There’s an open door for people to get involved, through me, in that rapid process of getting this new organisation in place. So, come the autumn, we want to re-launch a new, leaner organisation which is going to be of immense value to the rest of the NHS.
“Some of the DNA will be the same; we’ve got some people regarded as the best in the world. But it needs to look and feel different in terms of being really responsive to the challenges that people face.”
“Our focus is on how we get more support to people to deliver quality and effi ciency together, because even if it was the right thing to deliver just fi nancial effi ciency – which it’s not – people are running out of road on that.”
Easton told us the precise structure and branding of the new organisation is yet to be decided, admitting the current landscape of organisations involved in improvement work is “pretty complex”.
He said: “I’m not particularly interested in some fancy-pants branding that doesn’t mean anything. It needs to do what it says on the tin, which is how we get great support to local organisations and to frontline staff to tackle the changes.”
Laser focus?
We asked whether the new body should look at improvement across everything the NHS does – or prioritising the main challenges facing the
health service.
He said under the new structure, he wants clear ‘streams’ of products relating to common messages relevant both to senior leaders and frontline staff – the “shared issues”. “But,” he said, “we also want to leave some space to respond to particular challenges individual organisations have got, so we can develop some bespoke solutions.”
He wants seven or eight key streams, he said, such as delivering better outcomes, integration, delivering QIPP, world-leading commissioning, and so on. If they are as good as things like the Productive Series, “people will fall over themselves around the world to use them.”
Leadership
The leadership and improvement functions both fall under Easton’s purview and involve some similar issues.
He said: “We do get the same kind of questioning with both, and occasionally cynicism – people wondering ‘why is it the role of the centre to be providing this support?’ And I would be really happy with a system that didn’t need this: one in which the system was organising its own support. Maybe we’ll get to that, but right now there’s a strong case, if the capabilities are of really high quality, for a place where the NHS can work together to develop the right solutions and get them disseminated quickly and effectively within the family.
“My aim is that it’s something that will allow people to accelerate some of the sleeves-rolled- up clinical change they need to provide: high quality care at the frontline with the money we’ve got. And that it becomes the go-to place for the system to get advice and support or contribute to that change.”
Not just salami-slicing
Easton has spoken in the past about the difference between managers using service redesign to add value and take out costs – what QIPP should be about – and those who are actually just going for short-term cost savings and abandoning quality.
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