A desire to cooperate: could it bring us through hard times?

25 September 2014

Chris Streather

Last month I spent an interesting Tuesday with 25 health care leaders from across the country discussing approaches to quality in times of austerity. Our brief was to tackle the question of whether the NHS can maintain quality in the short to medium term without additional resources.

The event was hosted by the Foundation Trust Network (FTN) and the OnlyWan, and I helped facilitate. Acute trusts, ambulance services, mental health trusts and community providers were all represented. Chairs, CEOs, finance directors, nursing and medical directors were all there. The workshop was deliberately circumscribed to provider-land but we did have the benefit of a lone commissioner who, uncharacteristically, we didn’t gang up on. Medicine is OnlyWan, the FTN and me as an AHSN leader, I hope provided some cross-system linkage.

Our plan was to use hypothetical scenarios to help guide a free thinking discussion. This worked well, especially as the challenges faced by ‘Holby NHS’ – our fictional medium-sized acute provider trust with integrated community services – seemed to ring true for many in the room. Our trust was projecting a £4m deficit this year, deteriorating to £30m in 2015/16.

We went through three exercises:

  • In the first exercise we were asked what trade-offs or sacrifices we might make if cash was absolutely limited (with no bail outs) in the short and medium term.
  • In the second exercise we were allowed to change the rules of the health and social care system, and came to a consensus about five old rules to discard and five new ones to introduce.
  • In the final exercise we were allowed a (pre-election, hold that cynical thought) bail out, but the scenario assumed that we would deliver anyway and that the bail out would be ‘extra’ cash to try and build a sustainable system.

The details of our discussion are in the formal write up, but there were some interesting themes that particularly resonated with me...

In the first scenario, most thought we might be able to cope with year one and preserve quality, but that the medium term was much more tricky. There was universal agreement that a health economy approach was necessary, with a degree of cross-organisational cooperation that is not the current norm.

In the second, quite a lot of imagination went into new rules (and also some settling of scores) in terms of the five things to go into NHS room 101. However the mood was surprisingly upbeat, and again cooperation – including closer working across the health and social care divide – was a common theme.

In the final scenario, with a bail out, there was a pleasant surprise. The desire to cooperate that was identified in the cash-limited scenarios was preserved. This allowed some opportunities both to invest to save, and to build community capacity, with a limited period of double running to manage the burden of long-term conditions earlier in pathways. This ought to deliver the alchemic achievement of lower cost and better quality experience.

As a managing director of an organisation that crosses health, social care, third sector, academic and commercial boundaries, this is heartening. If we are to meet the triple challenge of money, demographics and Francis together, without unwanted trade-offs, it has to be via less siloed ways of working.

Of course there was much more discussed on the day, and if you read the report you’ll also see the views on targets, regulators and the professions. What about you? I’d be really interested to hear your thoughts too – add them in the comments below.

Chris Streather is Managing Director of the Health Innovation Network South London, www..com/dulwichchris

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