5 August 2015
Pausing to reflect after a hectic couple of weeks of meetings and events I realised that there is a thread that has been central to all discussions about the NHS Five Year Forward View
and the future health and social care policy, and that is the need for a major change in culture. In fact, if I was to create a word cloud image from the numerous presentations myself or colleagues from LOCSU have attended of late, I’m pretty sure that “culture” would dwarf all other words in the graphic.
At the new care models event at the Kings Fund in London’s West End last week “cultural change” was definitely a key theme. Throughout the day, health care leaders from NHS England, vanguard sites and from as far away as Australia and the USA, were unified in the view that health care professionals, managers and patients need to embrace new ways of working and interacting with each other, and ultimately develop a culture of shared ownership for new care models and the future NHS to be a success.
Moving across London the next day to Commissioning 2015 at the ExCel, various panels of distinguished health and social care leaders were singing from the same hymn sheet as those that had presented at the Kings Fund. Changing culture and developing incentives to encourage multiple providers and multi-disciplinary teams to work together across patient-centred pathways were high on the list of recommendations put forward.
In one session RCGP Chair, Maureen Baker, highlighted the age-old problem of inter-professional barriers stating that the constant undermining of the value of general practice is unprofessional and shouldn’t be tolerated. While, perhaps unsurprisingly, both I and colleagues from Pharmacy Voice had to remind colleagues from other professions and sectors that primary care is about much more than general practice, waving our we are primary care flag once again. In order to change culture we all need to take time to understand and appreciate the roles that others play, whether they are on the front line or in the back office.
In a recent joint publication A Call to Action on the Future of Health and Wellbeing Boards, the Local Government Authority and NHS Clinical Commissioners called for support for Health and Wellbeing Boards (HWBs) in bringing about a radical transformation in the health of our communities. The document states that senior leaders need to come together to take a place-based, preventative approach to health improvement and tackling health inequalities and that boards need to be bold, and use their existing powers and innovate for health improvement.
Now that all makes complete sense to me, as it will to many people, as it is only the HWB that has oversight of the entire local health and care system as well as factors that impact locally on health and health inequalities such as education, housing and employment. But can it really be achieved? This collaborative approach is an acute example where significant investment in relationship building is required before any positive impact on delivery of services is seen and many areas have struggled to overcome the cultural and behavioural challenges which stand in the way.
My view is that we desperately need HWBs to step up to that challenge and drive a great big steam roller through those barriers. HWBs are well placed to facilitate greater engagement of commissioners with local communities and with local health and care providers so that commissioning reflects their needs and builds on existing services to ensure that they are fit for the future. HWBs should also be advising on what is the right footprint for commissioning local services; many large trusts provide services to more than one HWB area and more than one CCG area, in which case it may not be appropriate for commissioning to take place on a single HWB or CCG footprint.
Coming back to the relatively narrow sphere of the eye health and sight loss sector I would suggest we can be proud of the progress that we have made in changing culture and working collaboratively, for example, by producing a sector-wide response to the Call to Action under the banner of the Clinical Council for Eye Health Commissioning and by coming together to focus on delivery of the UK Vision Strategy. There are some excellent examples at local and regional level too.
Fantastic as this progress is, it is not enough and stories of people putting up barriers that scupper collaborative efforts are sadly all too common – we need to do better. Whatever our role, wherever we live and work, we all need to accept that some things will need to change and new care models will emerge. Rather than sit back and worry about what impact that will have on our role we need to go out and grasp the opportunity to get round the tables with commissioners, HWBs and the Local Eye Health Networks and support each other to come up with the best solutions for the patients and public in our communities. By creating a new culture club of our own our sector can lead the way for the future NHS.
VISION 2020 UK CEO Mercy Jeyasingham comments on LOCSU article: Time for a new ‘Culture Club’
At our recent meeting of the Chairs of the VISION 2020 UK Special Interest Groups we were shown a slide by Abigail Rotheroe of New Philanthropy Capital whilst discussing leadership and collaboration. The slide summed up research on why things do not change. It offered a neat formula: being dissatisfied with the current situation x a compelling vision x practical steps to change needs to overcome resistance.
Abigail’s research led to the conclusion that resistance is often about history and culture – a set of ingrained beliefs that ‘we’ve always done it this way’. Organisations also have to acknowledge and be up front about vested interests. Let’s face it – sometimes collaboration in the short term might look like giving away more than you gain. However it is that compelling vision of the future that helps some far thinking organisations overcome this as well as having trust in the people you work with along with those practical steps.
I am beginning to see not only this culture change, as the article outlined, but effective collaborative projects within the sector. The work of our Special Interest Groups is a good example. For instance the portfolio of indicators produced by the VISION 2020 UK Ophthalmic Public Health Committee, and recently endorsed by the Clinical Council for Eye Health Commissioning, should lead to substantial change. It will certainly lead to greater knowledge.
Influencing the wider system needs all our efforts and it is more likely to change if we are working together.