Forward view analysis: Tackling the ‘how’

After a number of years spent in developing, reviewing and implementing strategic plans in both the private and public sector, I read the NHS Five Year Forward View with real interest and curiosity.

I considered the implications as a relatively new NHS employee, but also as a taxpayer and current and future consumer of the services. In public services, those employed to deliver wear many hats relative to their organisation. There are three areas I found interesting and relevant to my experiences.

‘There’s a lot of good practice to draw support from this rational view of what we need to do’

The first is the challenge of prevention, with an explicit admission that this huge influence of future healthcare demand is not within the remit of the NHS to manage or control.

In fact, even influencing the agenda is highly dependent on the willingness of other public sector agencies. Reversing the current trend requires behaviour change on a grand scale against the background of a world that has changed quickly and irreversibly.

In the field of physical activity alone, urban development, accessible open spaces, school environments and the pace of working lives underpinned by technology development flies in the face of a small number of pioneering healthcare professionals promoting physical activity for health.

Joined up care is necessary

In the city I work, where social and health inequalities are significant, joint working is more than “nice to have” - it’s necessary.

National recognition of the shared ownership of this challenge across government departments would be most welcome in response to the importance placed on this aspect of health.

In advocating prevention as a health imperative, the forward view appeals to everyone who believes in individual responsibility and accountability, empowering people to look after themselves.

Having firsthand experience of developing a model of integrated health and wellbeing, the second area of interest in the forward view is the discussion of new models of care in our communities.

‘I welcome the view that there needs to be a variety of approaches’

I welcome the view that there needs to be a variety of approaches based on local need and providers.

When I first joined the NHS I was quite transfixed by the commissioning complexity and the fragmentation of local provider networks that means that two similar areas (demographically, economically or geographically) could have completely different provider structures.

The forward view talks about partnerships and herein lies the real common ground across all localities.

If radical change is to be achieved without massive provider restructuring, partnerships are the solution. My own experience of partnership working is that when there is a single, absolutely agreed imperative - for example, staging the London Olympic Games in 2012 - many organisations find ways to flex and work together that they had never dreamt of.

However, these are partnerships of convenience and as soon as the imperative recedes, normal operation resumes.

The partnership priority

Genuine, sustainable partnerships based on mutually recognised interdependency and trust is the only way to deliver long term improved health outcomes. Facilitating the development of these partnerships, and recognising and celebrating them, is an important priority for all those working in this space.

I have been fortunate enough in my time with NHS Leadership Academy to review healthcare systems and public governance generally with thought leaders from the Harvard Kennedy School. One of the lenses through which we view systems is the authorising environment.

‘Genuine partnerships are the only way to deliver long term improvements’

This describes the (sometimes unwritten) boundaries, both formal and informal, that influence behaviours in an organisation or service.

My own experience of the most highly regulated agencies is that a strong adherence to perceived authorising environments significantly affects behaviours across the system, creating some barriers and also occasionally some quite dysfunctional operation.

Breaking down these barriers whilst adhering to safety and quality is another significant obstacle for new models of care, including navigating of the minefield of data protection and management in multiprovider partnerships.

Won’t be easy

Perhaps the most interesting area is the aspiration to have an integrated approach to mental and physical health.

‘The forward view offers support for real progress’

Coming from an environment where care of mind and body for better performance are inextricably linked, it feels intuitively right to want to achieve this objective. This links back to partnership working in the first instance, as it’s not an easy journey to embark on from the current service delivery in many areas.

The forward view offers support for real progress and there is a lot of good practice which can draw support from this rational view of why and what we need to do. The real challenge for all of us is the how.

Zara Hyde Peters OBE is part of the NHS Leadership Academy Executive Fast-Track programme and programme director of health and wellbeing at Birmingham Community Healthcare Trust