The forward view should shape a culture that appreciates what works, says Dame Carol Black and Raj Bhamber

The media spotlight on the NHS Five Year Forward View when published in October brought a welcome cheer.

‘Culture change must start with a recognition and reassertion of values deeply embedded in the ethos’

Too often the NHS has been portrayed as broken. Not only is this dispiriting for existing staff, it discourages the next generation whose career choices are influenced by many things, including public perceptions.

Most individuals work in healthcare because they are driven by fine, simple motives – to support and care for people at times of acute illness or injury; to help restore them to good health; to support them in the shared management of long term conditions; and where possible, to help prevent or delay illness in the first place.

Carol Black PwC Health Industries oversight board

Carol Black

Their motives and talents bring life into the very heart of the NHS and define its culture. They warrant celebration, not despair.

The forward view sets a clear future direction for healthcare and provides an opportunity to shape an enabling culture on an unprecedented scale.

The international research and evidence base developed by Jon Katzenbach shows that organisations achieving peak performance and competitive advantage have done so by getting their culture right through applying five principles:

  • match strategy and culture;
  • focus on a few shifts in critical behaviour in moments that matter;
  • honour the strengths of the existing culture;
  • integrate formal and informal interventions; and
  • measure and monitor cultural evolution.

Leading questions

The new blueprint for the NHS signals the importance of critical behaviours. It highlights the force of true partnerships and joint accountability within and across organisations.

Raj Bhamber PwC director

Raj Bhamber

It emphasises the importance of a climate where leaders at all levels are listened to, where their views are valued and where they feel able to express their opinion openly without fear.

This requires transformed leadership at every level of the NHS: leadership that welcomes challenge and constructive criticism.

While the forward view provides an opportunity for a cultural revolution of a kind, culture change must start with a recognition and reassertion of the values that are deeply embedded in the ethos of the service, and supply its essence.

‘If successful, then the forward view will shape an enabling culture that appreciates more fully what works well’

They are contained within our notions of public service, of professionalism, of courtesy, respect, dignity, and deep pride.

There is a growing evidence base that shows organisations which focus on the health and well being of their staff are twice as successful as organisations that focus on performance and health and well being together, and they are three times more successful than those that focus on performance alone.

It will be important to monitor the impact of the cultural transformation in the NHS during the next five years, in response to the changing world of health and work.

Longer lives

Both employers and staff will be introducing new ways of working. Many staff will have longer working lives than was usual in the past and portfolio careers will become the norm.

The reconciliation of potentially competing interests of employers and staff will be fundamental to maintaining the reputation of the NHS as one of the world’s best healthcare systems.

If successful, then the forward view will shape an enabling culture that appreciates more fully what works well. It will build on those foundations, creating a richer culture that will endure and flourish within the context of an ever changing and challenging environment.

Dame Carol Black is a member of PwC’s Health Industries oversight board and Raj Bhamber is a director for PwC

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