At a guess, over the two and a half days of the NHS Confederation conference, around 200,000 words were spoken on stage. Inevitably, with such quantity of verbiage, some of those words get repeated, and speakers have to go to increasing lengths to make their points stand out. So, as a recap for those who made it to Manchester, and an introduction for those who didn’t, here’s a run-through of the metaphors of the week.
Do: grasp the nettle.
As has been the mantra at such events ever since austerity started to bite, nearly every talk has begun with a quick recap of the challenges facing the NHS – be they financial, quality, or staff morale. As such, there have been frequent exhortations that now is the time to make the changes that might have been put off previously.
Don’t: scare the horses. So make radical change – but try and do that by working with and engaging staff and patients. Or rather, such engagement is the only way you’re going to be able to make radical change. The importance of workforce issues as fundamental to the future sustainability of the NHS fully rose to the fore here; the Health Foundation’s Anita Charlesworth describing workforce as “the NHS’ number one financial risk”. Don’t: be a goldfish jumper. Closely following any conversation of staff engagement is the role of culture, the topic of the week’s most fascinating session led by Stefan Cantore of the University of Southampton. To cut a long allegory short, we are all defined by our relationships, we live in a social world, and trying to pretend we don’t is like a goldfish jumping out of its pond (ie. not helpful). What the discussion put so starkly was the vast disconnect between the importance (and impact) of culture change through reflective conversations, and the way local providers felt they were being treated by national bodies (“a million miles apart” to quote one Trust CE). Do: go drains up. Which brings us to the irony of one of those national bodies, NHS Improvement, now being led by Jim Mackey, on secondment from Northumbria NHS Foundation Trust, one of England’s leading Trusts for staff engagement. In what was widely recognised as the speech of the week, Jim set out how much amazing work goes on every day in the NHS, and how significant the service has changed over recent years (music to the ears of the members of the UK Improvement Alliance). But he stressed such change has to be ratcheted up a couple of notches, to leave no stone uncovered, to go ‘drains up’ so to speak. Don’t: expect fairy dust. Because without such relentless focus on change, the prospects for the NHS don’t look good. Without an extra infusion of cash, or again, in Jim’s words, the unlikeihood of fairy dust, the only way the NHS avoids a potentially significant dip in quality is to improve efficiency, and quickly. The question remains about whether such change is possible (never having happened in any health system, anywhere in the world, is never a good starting point), but this focus on relentless improvement was welcome. Do: treat your STP colleagues like your children. The Confederation conference wouldn’t be itself without a major presence of the year’s new acronym: STPs (sustainability and transformation plans for those of you with better things to do). The aim of STPs is to bring health and care bodies together across an area to plan how best to deliver health and care (within the money) for an area. Nice idea in theory. Tricky to execute in practice, given the time and effort needed to build relationships between (and within) disparate bodies. This requires a new mode of operating for many in the NHS, described by Amanda Doyle as switching into Mum mode – being able to give orders which may not necessarily be followed, and doing it because you care, not for a personal reward. Don’t: pull up the drawbridge. Which reinforces a central element of our work in the UK Improvement Alliance, a network of organisations dedicated to improving quality of health and care. It’s not a formal hierarchy which directs our work. Nor can anyone be ‘fired’ from our membership. We have come together as a network because we’ve realised that we can achieve far more for our local populations working together in improving quality, than apart. Drawing on expertise and commitment from across the UK, I’m incredibly excited at the potential to make a significant impact in challenging times. It has been great to have a range of conversations with colleagues this week, both inside and out of the Alliance, similarly enthused by this potential. Our drawbridge is firmly down; we will shortly be taking on our first members outside our founding cohort, and if you share our commitment to quality and learning, we'd love to hear from you. Interesting times lie ahead. Do: scratch your head at the samosa structure. No. Me neither. Richard Taunt is Director of the UK Improvement Alliance. Follow Richard on Twitter at @richardtaunt.