In her third post in the #Transformation2019 series, Sue James tries to answer the question about how well prepared we are for the transformation journey in the five years ahead

Nationally, our health and social care system is woefully ill-prepared for the journey we now need to embark on.

If we are to maximise the impact of our transformation work and investment in the health and social care infrastructure (that this country can afford) we will need to change:

  • organisational boundaries which create silos and separation;
  • a funding system that is different for health and social care, and was designed to meet the needs of  a different, and more affluent era;
  • training systems; and
  • current regulatory systems.

This is not an exhaustive list. What would you add?

Person caught in the rain

Like someone caught in a flash storm, the NHS is not prepared for the level of change it needs to carry out

The biggest problem we have is that the strength of the NHS in the past is now becoming its major weakness. 

The fact that we are funded from general taxation means that the public and the media regard a publicly funded NHS as “theirs”, and not to be meddled with. The political risks of making major changes to service configuration and the compact between the service and its users are all too apparent to politicians who react by pretending that levels of investment in the NHS are generous (which they may be in relation to other publicly funded services, but are certainly not in relation to levels of need) and the NHS can therefore carry on as before without radical change. 

This national perspective affects the view of local patients and staff who are not yet bought in to the bigger picture challenges of rising demand and falling real time resources. Creating a national narrative to challenge this thinking is essential to provide a context for local change, but won’t happen when a general election is in the offing.

The difficulties of changing public and staff expectations are easily underestimated, as shown by the recent reaction to Care.data. This national narrative needs to have some well publicised examples of successful change, with patients affected by it being ambassadors for it.

We are woefully ill prepared and I hope between us we can make the list above more comprehensive and start to share approaches to start our preparations.

In my next posting, I will address the level of collaboration needed to achieve the transformation required.

Sue James is chief executive of Derby Hospitals Foundation Trust

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