29th January 2016

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Former Secretary of State for Health and now Chair of the Confed
Stephen Dorrell
Last few tickets 

Defined by change
News and Comment from Roy Lilley
Wednesday was Helen Bevan's international NHS Transformathon.  Global, 24hrs, talks on innovation, ideas and service change.   We did our bit on the Academy of Fabulous Stuff, then the Australians took over the baton and told us about their good stuff and then daisy-chained around the world.

The pressures, in the NHS, that are combining to create the clamour for transformation, are part of a worldwide phenomenon. 
Demand, costs, technology and the inability of most governments to fund services adequately.  Even in co-payment environments costs are  moving towards unacceptably high levels both for Governments as payers and tax payers as funders with the double-whammy of taxation and commercial premiums.
The new buzz-word; transformation.  

Four strands of thought come to mind.
The first, strategic issues; I regard 'strategy' as something of an anachronism, born of the military, its hierarchies and seigecraft.  More likely, in today's rapidly changing environment, tactics and techniques might be more helpful. 
If strategy has any currency it is to help us to think more clearly about what we want to achieve.    What kind of transformation?  Is it the transformation of the whole service, or parts of it?  Is it more appropriate to transform the organisation before transforming the service?
The NHS is a whole system and interdependent so, should transformation begin with the primary care sector where access and service frailties feed demand into the wider services.  

Or, social services; overwhelmed, their difficulties bringing crippling problems for secondary and community care.  

Maybe hospitals in silos; should they be transformed into more vertically integrated models.
We need to be clear about what actually needs 'transforming'?
The second issue; the 'vision thing'.  I'm not a fan of the ethereal visions beloved of the mission and strategy writers.  However, in the right context, they can be important.  What does the future look like?  What does good look like.  What does a transformed service look like?  Most organisations can do the 'vision thing' but can't deliver the services to match.

That's why we are trying to help with the Academy of Fabulous Stuff.  Showing everyone what good looks like.
Why do some people struggle with the post-vision delivery? Maybe the technology proves not up to the task.  People don't have the skills.  The information and data that changes are predicated on, proves to be incomplete, inadequate or wrongly interpreted.  Most common of all; the risks of change are under estimated.  Risk registers, too timid and do not reflect the actuality.
The third strand; leaders and key people.  In transformed organisations there will be unexpected, bigger roles for some people.  For instance, in the NHS little attention has, thus far, been paid to data.  The future will be predicated on the management of information by the use of technology. 
The data miners and managers will appear, centre stage and some become boardroom players.  They may reveal uncomfortable truths that established management with find difficult to accept.  Relationships will come under new pressures. 
Bringing in new 'transformation' people can be unsettling for staff.  A new 'digital gun' may bring in some quick fixes but they are unlikely to work unless staff are trained, have the knowledge base and the confidence to work change forward.
The second group of people are 'the losers', the existing leaders; how capable are they of leading a transforming organisation.  A life that was assured and successful becomes disrupted and uncertain.  What is the succession plan?  How will the old leaders give way to the new guard?
Finally, the customer, patient and service user; what is in transformation for them?  NHS' existing service models may be familiar and feel safe.  Moving services, consolidation, new approaches can undermine their confidence. 
At the same time customer frustration with, say, access to primary care, may well drive them to look for their own disruptive, transformative solutions.  For example, Babylon or similar Apps, giving instant access to GP advice, could easily undermine the cohesive, shared-risk approach that underpins the success and values of the NHS.
No successful transformation is ever top down.  The need for transformation has to be made obvious to the front line, they have to understand the reasons, be excited by the ideas and want to be part of it. 
We all love change if we feel we are in charge.  You don't transform organisations; you transform thinking and recognise the path to transformation is through mistakes.
The world of the NHS is defined, largely, by repetition, the paradigm shift is to a world defined by change.

Have a good weekend.
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11th February at  
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Prof Sir Mike Richards
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1st March 2016
King's Fund 5.30pm
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Stephen Dorrell
Former Secretary of
State for Health
Chair of the Confed.
'the reforms were the biggest mistake of the Parliament'
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At the Edinburgh Fringe
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