Our recent North-West Learning Collaborative masterclass highlighted the need to look beyond structure and process
Anna Littlewood, Associate
Over the last few years, I have worked for a large consulting firm, and taken a senior operational role within a large university hospital foundation trust, before joining an IMPOWER consulting team delivering Adult Social Care transformation.
Moving from consultant to client and back again, and from Acute Provider into the world of Adult Social Care, has given me a perspective that few others observe. I wanted to share 6 key insights that I hope we can all use in our work across the health and care interface.
As the Deputy Divisional Director for Diagnostics and Therapies across nine hospitals, I had overall responsibility for a number of services as well as being on the on-call rota. Being on-call meant that for a 24 hour period every 30 days, I was the senior manager responsible for the out-of-hours operations of eight hospitals.
Not having an NHS background was a mixed blessing as I navigated the complexities of hospital finances, performance measures, operational protocols and the unique role of medical consultants. I learned a lot and also brought a fresh pair of eyes and an ability to ask simple questions about Delayed Transfers of Care (DTOC), length of stay, A&E targets, discharge dependent activity, and demand and capacity planning.
Adult Social Care
Moving across to Adult Social Care was a marked change of pace and culture. The IMPOWER team was focused on the interface between health and care, working to ensure that the intermediate care offering was fit for purpose and could properly facilitate timely and supported discharge from hospital. We brought system partners together to set up a Home First service, and focussed on transforming the Reablement Service to increase weekly case loads and reduce length of stay.
The local authority that we are working with is investing time, staff and money to transforming their part of the system, recognising that the only solution to reducing high city-wide DTOC numbers and costly long term placements is to do things differently rather than patching up the problem with injections of Better Care Fund cash.
From these experiences, I wanted to share my six main insights from the health and care interface,
- In both settings, the lack of funding permeates culture. In the hospitals in particular, this is felt acutely in day to day operations particularly, concerning staffing. The injection of Better Care Fund (BCF) cash has helped to divert some resources from firefighting into focussed transformation activity. Yet the reality is that the majority of BCF monies continue to plug overspends or savings shortfalls. Additional funding invested appropriately would mean that senior operational staff would move from firefighting mode to having the headspace to implement bolder and more far reaching internal changes to operations.
- Acute hospitals live in a bubble where what is happening right now trumps all other pressures at every level of the organisation. In Adult Social Care the pace is slower and the end game is long term. There must be a happy medium between the two cultures where high pace of change and a drive for results meets system-wide sustainable transformation.
- Acute hospitals feel that they bear the brunt of the problems born out in the system and consequentially have the loudest, most urgent voice amongst local partners. To staff in Adult Social Care this can feel as though their solutions (or need for funding) rarely get prioritised over the acute hosptials’ needs. The sense of urgency, particularly over winter, can inadvertently divert resources and attention away from community services that keep people out of hospital.
- Most people at senior levels in the NHS have grown up through the ranks and I was surprised by the enthusiasm with which my different background and perspectives were received. The NHS and consultancies need to find a way to cross-pollenate their resources – there is a great opportunity for both sides to share expertise, experience and energy for the greater good.
- I miss the level of authority and influence that I had in my operational role within the hospital. This is how real change is effected from within. Now as a consultant, I seek out the key operational influencers who will make the bold decisions required alongside my work as a consultant.
- And finally, something that I am still trying to fathom having worked for years for a private sector organisation is the level of adversarial rivalry within the wider health and care system. In this public service system, where there are no financial stakeholders, no intellectual capital to protect, and most importantly no markets of customers to fight over, the level of mistrust, open criticism, eye-rolling and unhealthy competition is often baffling. The root cause of these behaviours is difficult to understand and overcome, yet if we could all work together with passion, enthusiasm and trust, we would ultimately deliver a better system for all those we care for. I am not tarring everyone with the same brush, of course. But I have been struck by how the behaviours of a small minority can affect so many.
I continue to have the privilege of working in this space to facilitate real change, the impact of which I hope will be felt on the wards and corridors of the hospitals I used to work in.