Change at pace and scale – the NHS one year on

Deputy Medical Director Dr Mike Bewick takes stock of how far the NHS has come and what more needs to be done:

With NHS England reaching its first anniversary last month, I think now is a good time to reflect on what we’ve achieved, and what we need to get better at.

For me, the new, clinically-led system is much less hierarchical and more open to innovation, pulling in ideas and views from doctors, nurses, commissioners and patients to improve treatment and care. At the same time, it’s also more centralised, as we work to ensure uniformly high-quality primary care and specialised services across the country, wherever in England people live.

As a doctor working for NHS England, I’ve learned a lot over the past year. Some of it has been very uncomfortable and painful for us all: not least serious failures in hospitals that were discovered through the Keogh Review. We have worked hard to understand where patients have been failed, and make sure the right action is taken.

Throughout this process, it remains clear to me that patients and carers – even those who have had very difficult and traumatic experiences – still trust clinicians. Therefore it is our duty as clinicians to drive change in the NHS, be leaders as well as critical friends. We cannot just step in after the fact.

But we have a difficult job to do. The health system is a very busy place, in terms of activity but also the number of players on the pitch. It’s difficult enough for doctors and organisations who work within the system to navigate the complexities, so how can we expect patients to do it? How do we lead change for the benefit of our patients?

First, we need to improve and simplify the way we do things. We need patients, health professionals and organisations to understand how it works. We must also make sure we don’t just respond to regulation, but set the agenda and deliver great care.

We have to accept that access and quality varies and it is the job of CCGs to do address this. We also know that we won’t get it right every time, but primary care is a great example of delivering real change when we do get it right.

Over the year, I have seen first-hand how some in primary care are moving away from talking about the number of doctors towards describing high-quality care. We are getting better at describing what good looks like, and aspiring to deliver it, every time.

I’ve also learned that describing specifications for rare and complex conditions is very difficult. We began with a legacy of complex commissioning arrangements and variable quality in services across the country. The task of unravelling these and translating them into a common language and agreeing quality measures has been very difficult.

While there are risks attached to translating complicated processes and treatments into terms we can all understand, those with rare illnesses and cancers deserve better, so it’s vital we use the opportunities of central clinical leadership to revolutionise, and improve their care.

Finally, I’ve learned that those who talk about injustice in mental health and how we must address the significant issue are rarely in a position to change it. We need action and a real understanding from professionals in both mental and physical health of how much crossover exists between the two, and how services need to be designed to look after individuals’ physical and psychological health at the same time. I hope Parity of Esteem gets to grips with this and puts mental health at the heart of all commissioning intentions.

These are just a few of the many challenges facing the NHS but I’m an eternal optimist. I have seen change that has been adopted at pace and at scale – Major Trauma Networks for example have reduced mortality from serious injuries by an unprecedented 20% in just three years.

But we need strong clinical leadership to make sure we deliver more of these transformative changes. GPs, nurses, pharmacists and allied health professionals up and down the country are redesigning services for the benefit of patients.

We know what we need to do, and by working together to develop ideas and build consensus, we can make it happen.

Dr Mike Bewick is Deputy Medical Director at NHS England.

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