As part of our ‘What If’ series on change in the NHS, we spoke to Transformation and Turnaround Professional Steve Burke 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…
Having spent over 12 years in the NHS in a variety of consulting roles – mainly focused on transformation and turnaround challenges – I have seen huge change. Some of this has been progressive but unfortunately, a lot has been unsuccessful, failing to deliver both sustainable benefits for patients and staff, or efficiency gains and financial improvement.
A key factor, which I believe is causing suboptimal and inefficient delivery of healthcare, is “Silo working”. I refer to organisational structures that lead to poor integration of working practices, resulting in inefficient allocation of resources and also in conflicting objectives and priorities. This is most obvious at the Macro level. Examples of this are the major reforms in 2012 and more recently, the development of artificial structures, including STPs and ACSs, in an attempt to improve integration and allocation of resources. These initiatives are simply a reshuffle and re-badging of existing resources and fail to address the root cause of the problems, often creating new barriers to joined-up thinking and coordinated healthcare delivery.
A major cause of the inability to develop effective integration of services and coordinated working across the wider Health Care Systems, including the NHS, is the way in which resources are allocated and financial budgets are set. Financial budgets follow artificial organisational structures from the top to the bottom of the whole system and the achievement of these is seen as the key measure of “success” and “efficiency” in today’s financially challenged times. This often leads to resources being allocated in an illogical and inefficient manner, sometimes resulting in perverse human behaviour, simply to hit targets that are not aligned with the delivery of successful patient outcomes.
As a Finance Professional, I completely understand the need to operate within existing budgets. However, it is time to examine how the allocation and delivery of funding can be structured in a way which incentivises best practice and coordinated actions from the bottom up.
Steve is a qualified Chartered Accountant who has worked for both larger international groups and smaller entrepreneurial companies. Over the last 12 years, he’s used his commercial, corporate finance and business turnaround experience from the private sector, to help drive significant improvements in financial and operational performance in public sector healthcare.
He provides expert consultancy support in transformation and turnaround, strategic planning, financial management, project management and has helped a number of Trusts significantly improve their financial position.
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