Long Term Planning
As part of our ‘What If’ series on change in the NHS, we spoke to Associate and Divisional Director Keith Dibble and asked him: “Putting all politics aside, if you could change one thing about the NHS, what would it be?”
If I could change one thing…
Apart from the obvious wish for enhanced funding to arrive, the greatest limitation I have found with the NHS is the inability to plan service delivery (and thereby cost savings) over a long period.
Short-termism stymies innovation and compromises true service transformation. I have seen too many sound medium-to-long-term strategies either cut short or watered down, so that achievements are greatly restricted. Changes in work-force models, for instance, can provide not only long term sustainability, but also greater economies of scale.
To give an example, in Ophthalmology, widespread use of optometrists and nurse practitioners will create a robust workforce for the future at a lower cost, as well as make better use of scarce medical resources. But this requires a minimum of a two-year lead-in, which in itself is likely to involve some double-running while staff are recruited and trained. The result then is often a scaled back version of the plan, with insufficient staff being brought into the frame, and therefore a less than sustainable solution being put in place.
If the NHS genuinely wants to follow three, five or ten year plans, funding needs to be made available to support longer term developments with genuine strategic direction, where evidence of real transformation can be provided. There are limited numbers of examples of this where excellent progress can be made, but generally the requirement to achieve the current year’s QIPP or CIP target prevails at the expense of the real change.
I felt this to be the case when employed substantively, but it has become even more apparent when I have been brought in to an organisation specifically with a transformational remit, only to find that the reality demands transactional change only.
This is beginning to change as Trusts are forced to work together to deliver health economy-wide improvements, but some of the entrepreneurial spirit within each organisation is often being repressed. To make real and lasting change, it needs to be unleashed.
Keith has worked as an interim for five years, prior to which he was substantively employed in the NHS at Associate and Divisional Director level, primarily in the Midlands.
The bulk of his experience has been in the area of Planned Care – Surgery and Women and Children’s Services – although he has other medical specialities as well. This pattern has largely continued in his Interim work, although his focus most recently has been around Mental Health transformation.
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