Rising and more complex demands on the NHS require radical reform from the bottom up, writes Jennifer Dixon.
At a recent Innovating for Improvement celebration event, teams funded by the Health Foundation to take forward improvement initiatives shared inspirational and heart-warming stories about the impact of their projects. One team from Airedale NHS Foundation Trust, providing telemedicine to support people with stammer, shared how proud they felt when a young man who had benefitted from the service told them, ‘I’m the happiest I’ve ever been.’
The NHS’s 70th birthday provides an opportunity to pause and reflect on similar experiences many of us have had working in the NHS, that form our own unique tapestries. These will combine our routine, everyday lives (however far from routine they may seem to others!) with some of our greatest challenges and successes, our happiest and toughest memories, and a myriad of people, friendships, patients, families, teams and colleagues.
Working under pressure
I have experienced all of this in my own career in the NHS that started nearly 30 years ago, working first as a health care assistant in a hospital I returned to many years later to work as a nurse, a manager and latterly as a director. I know about the relentless, intense operational pressure that’s a reality for so many NHS colleagues. The toll this can take on our own wellbeing, and that of our families, is undeniable, and can quietly creep into our way of life so that we stop even recognising quite how impactful it is.
We all react differently to these challenges. My experience is a curious combination of some of the happiest and most fulfilling memories with firm friendships and inspirational colleagues alongside some lonely and stressful moments. I remember feeling a huge weight of responsibility and the helplessness of being unable to solve complex and ingrained issues while standing in the middle of an overcrowded ED at midnight. In these moments, temporarily putting aside action plans and instead connecting with the people around me was a really important lesson.
Under such pressure, the opportunity to step back, pause and reflect, and do something different to improve services can be hard to come by. Too often this important work is done despite the system, rather than because of it. We see so many examples of NHS staff and teams doing just that, both within our own programmes at the Health Foundation, and much more widely.
Looking to the future
Improvements in digital technology, genomics and artificial intelligence will of course contribute to significant changes in health care as the NHS enters its next 70 years, but what remains at the heart of the NHS is its people. The Health Foundation is in the privileged position to provide NHS staff with the time and resources needed to design and implement changes that can lead to huge improvements in safety, quality and performance. This is both directly through our award programmes and through fellowship programmes such as GenerationQ, which support leaders to create the conditions for meaningful improvements.
At the same celebration event, grant holders and teams were taken through a ‘wild mind writing’ exercise, skilfully led by colleagues from Haelo, to pause and reflect – really reflect – on what’s possible now. Initial scepticism, hesitancy and anxiety were replaced by total silence and fevered writing in the room, as the participants embraced the opportunity to think about their own experiences of leading and implementing improvements, and to imagine the future possibilities. Despite all the difficulties and challenges, the overwhelming sense in the room was one of hope, positivity and possibility. Many described this as their most powerful experience of the day. People said they needed three things:
- to believe they had the power to make a change; and now they did
- to have the techniques and skills to design, test and learn
- the time to put this work into action.
I’m proud that we are able to support these teams with these. As we look forward to the next 70 years let’s not forget how hard it is to make a change, given the intense operational pressures and stresses of working in overstretched or under-resourced services.
We see NHS staff and colleagues across the spectrum of health and care, working together and leading improvements that are saving and improving lives, and it’s important to celebrate this on the occasion of the NHS’s 70th birthday. If birthdays are also a time for giving, then, looking forward, imagine what we could achieve together if we gave all NHS staff the time, resources and freedom to continually improve care. As one consultant at the event put it, ‘What could be a better way to spend your life than improving things for other people?’
Frances Wiseman is Assistant Director of Improvement at the Health Foundation.