Challenges associated with the regulation of NHS-funded services and what the wider healthcare sector can learn from them

The Simmons & Simmons Healthcare Hub dinner on 29 November 2018 discussed the challenges associated with the regulation of NHS-funded services and what the wider healthcare sector can learn from them.

The session started with introductory remarks by Baroness Dido Harding, Chair of NHS Improvement. Insights shared by participants in the subsequent discussion included:

Shifting the focus from regulation to improvement

The reinvention of Monitor as NHS Improvement is indicative of a desire to move the way that healthcare services are stewarded from a focus on regulation to a focus on improvement. This reflects the need for a wider cultural shift, with a central concept of learning from things which go wrong, rather than seeking out who to blame.

While there is a shift away from blame, participants thought that this should not mean a shift away from accountability, as it is possible to impose strong organisational accountability without individual blame.

Shifting to an integrated/co-ordinated approach

It was argued that the current NHS system needs to become less segregated, both at a national and local level. While a
decentralised approach encourages competition, it was suggested that being forced to compete is neither healthy nor
appropriate for the healthcare profession.

Instead, lessons can be learned from the many parts of the private sector, where providers both compete and collaborate as a matter of course. A collaborative approach would allow for integrated patient pathways, without discrimination between public, private and third sectors. The integration of the operations of NHS England and NHS Improvement is consistent with this approach. There is a need to simplify, streamline and adapt.

There is also with a challenge around co-ordinating improvement efforts. Logically, the worst performing areas should be
targeted with the best people, who should feel they will continue to be supported even if they are not able to implement
immediate, turnaround change. Longer term and more realistic goal setting and incentives should be targeted as a means to
encourage organisation wide improvement.

Changing the leadership style

There was a view that if the NHS leadership style is able to shift to put patients and staff first, the financials will look after
themselves. Solutions become self-evident when front line patients and staff are empowered to identify what is wrong.

Another approach is that leaders need to become more accepting of innovation. There has been a culture in the healthcare
sector that when a “better way” of doing things is proposed, it is labelled as dangerous. Individuals in the sector often feel they are not trusted to innovate, even when they are specialists at the cutting edge of their field. There was a widespread view among participants in the discussion that this needed to change.

The problems which are faced by the NHS permeate throughout the healthcare sector. They are problems which, participants agreed, cannot be solved purely through structural change and regulation, but rather require a wholesale culture shift. Some argued that technology is the key to this shift, others collaboration, still others competition, but the one uniting factor is that the needs of patients and front line staff must be foremost in the mind of every leader and manager.

The views expressed above reflect discussions in the context of this topic at the time and on which there were wide ranging views. Accordingly, these views should not be attributed to any one participant, any group of participants or participants generally.

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