Prof Andy Brooks
NAPC Clinical Chair
There is always a lot of change in the NHS, that is a constant. Right now, we are getting to grips with implementing the 10 Year Health Plan and the three shifts. We have tried a few times over the last few decades to make these changes, but never quite succeeded. Do we need to change how we do change?
As I write this, I am sitting in the coffee shop near the entrance of an acute hospital, about to go into a board seminar. I’m a sucker for pastries, so I sip my coffee and look at the last crumbs of my croissant. I wonder what the day will bring. The staff pour in through the main doors and the volunteers are poised to guide nervous people as they step over the threshold and become patients.
Hospitals are busy places, with what can seem like a conveyor belt of activity. Some see this as processes that require change to manage them well and as efficiently as possible. Others add to waiting lists as quickly as they plan to reduce them. Financial pressures remain a constant concern. Queues in A&E and beds in corridors shouldn’t be there, and some worry about how to fix that. For those involved in direct care, another day looms ahead wondering how to meet the multiple demands placed upon them. For people on the receiving end of care there will be unique interactions with multiple elements from a large institution.
As I look again at remains of my breakfast, was the most important factor the chef or the recipe? If the pastry needed to change, which of those elements would be the most important to change?
My observation is that the NHS loves to change the recipe. There is certainly no shortage of instructions about what services should do, accompanied by specifications, operating models and targets. The ask is then for the same local chefs in the same kitchen to use the same ingredients and come up with something better. This may be an appropriate approach for hospital-based care. Sending out new instructions might do the trick. If the aim is to produce slightly smaller croissants, more quickly and more of them, or make fewer croissants and more bread rolls, then new recipes might do it.
What happens if the local population don’t need croissants? What if we needed to change the range of food on offer? Would that alter which of the chef or the recipe needed the most attention? At NAPC, we think the attention needs to be focused more on the chefs, rather than more recipes of service specifications. We need to change how we do change. Why do we say that?
Neighbourhood health and care is less linear, less transactional and more relational than hospital care. Moving to a population health care service based on need, requires much more than changes to services. Understanding local assets is key. That means knowing the local kitchen, the ingredients that are available and importantly what the population needs. The kitchen is much more than health infrastructure and includes all the wonderful assets of communities themselves. This will require chefs who can design recipes based on local reality, working with communities rather than central diktat.
Whilst this is a deliberate oversimplification, we do need to shift the balance of where we are placing our effort. Hospitals don’t just need more recipes and community care doesn’t just need cookery lessons, however lets think carefully about how we do change.
At NAPC we have been listening to our members and working with local neighbourhoods as part of the National Neighbourhood Health Implementation Programme. Local leaders have told us they need support to navigate, and collaborate in the complex evolving systems they work in. The chefs need development rather than being handed out recipe cards. This is why we have our Leadership Development Programme. This aims to equip leaders with insight, confidence and tools to be the best chefs they can be. We haven’t just cooked this up (excuse the pun) from nowhere. It is built on and provided by experts and those with years of experience and succeeding in how to deliver local change.
If you are a budding chef then please join NAPC, we would love you to be part of a new way of delivering change, using local ingredients that will improve population health.
