Securing transformational change in the NHS

The uncomfortable truth is that the majority of change programmes fail, particularly those that face the type of overwhelming public and political resistance that many NHS change programmes face. PA's experience in delivering NHS change in North West London demonstrates the high levels of public and political resistance that have to be overcome to deliver much needed clinical change successfully. Truly transformational change does not happen overnight.

Allocating a change fund, as proposed by the former NHS CEO, Sir David Nicholson, would enable the NHS to take a long-term approach and achieve transformational change in organisations and behaviours. The NHS must ensure that any proposed change delivers real improvements. To do this there are a number of key factors that need to be considered.

Take politics out of the NHS equation

In almost every NHS reconfiguration, local politicians come under pressure to oppose change to appease an electorate that does not necessarily understand the complexities of modern healthcare provision. We need to reduce this pressure, take politics out of the NHS equation and ensure cross-party support to achieve success.

Find new ways to engage patients and clinicians in shaping NHS services

There are countless examples of large consultation exercises that have served to generate ill-informed campaigns. The NHS must find new ways of engaging patients and clinicians in a meaningful way that informs and strengthens the design of new ways of working in the NHS. Engagement needs to provide real opportunity for people to influence the improvement of NHS services. Creative use of social media may also allow greater patient involvement in development of services as it can reach a much wider range of people, including those who do not usually engage in service design.

Focus on transformational change, not piecemeal adjustments

For several years, there has been a major drive to deliver on small-scale, local cost reduction programmes. Individual, isolated, piecemeal change will not suffice in delivering major transformation. The NHS has now set an ambitious, long-term blueprint to revolutionise how care is provided; this must not be diluted if the NHS is to survive.

Transformational change in the NHS is the only way to avoid a decline in the quality of NHS care and a collapse in public confidence in the institution. To achieve this, there must be cross-party commitment and politicians must be ready to engage with the population to challenge popular misconceptions about how real value can be released.