Right Care, Right Place

Wed, 5 June 2013

Unless the NHS faces up to the need to change how it delivers its services, it will descend into a 'vicious spiral' of poorly planned, reactive responses resulting in unsustainable demand, according to three organisations which have joined forces to call for a better approach to NHS service change.

The three organisations together represent royal medical colleges, patient groups and NHS organisations. It is the first time bodies representing all three major parts of the health service - patients, clinicians and its senior leaders - have come together to examine the need for changing how services are organised and how best to do so.

The NHS Confederation, National Voices and the Academy of Medical Royal Colleges are calling for 'more meaningful' engagement in how health services are arranged and changed with all those groups who are impacted by them. It says past experience of NHS changes, which can be driven by financial or clinical crisis, has polarised the debate to the extent that the service risks being paralysed, even though major change is essential for its successful future.

This new report, Changing care, improving quality, says rising demand and limited resources mean the reorganisation of services is essential for the NHS to remain sustainable and to continue providing safe, effective clinical care that meets patients' needs. It says that the term "reconfiguration" has become loaded with negative meaning, associated with making cuts and downgrading services, and that service changes are frequently viewed by the public as a threat rather than positive and necessary reforms.

The report says that making the case for change must happen earlier and that public and patients need to be fully involved from the outset. It emphasises the importance of a whole-system approach so that communities do not perceive change as a loss but understand how reinvestment in community-based services will deliver the quality and access they prioritise.

Published on the first day of the NHS Confederation's annual conference, the report calls for meaningful engagement of the public, patients, politicians and health professionals in proactive, well-planned service changes, and highlights the highly influential role for clinicians in communicating a clear case for change.

It sets out five recommendations each for local health service leaders and their national counterparts in order to ensure essential reconfigurations - underpinned by sound clinical reasons - can proceed with the understanding and support of relevant stakeholders.

Mike Farrar, chief executive of the NHS Confederation, said:

"More than two-thirds of NHS Confederation members have told us 'political resistance' is the biggest barrier they face in relation to successful service reconfiguration. But political courage by itself is not enough to deliver the kind of change that the NHS needs at this point in its life; the service itself must overcome its paralysis in relation to change, and it must bring the right people with it.

"It is not good enough to say that it is 'difficult' to communicate the need for change to the public. Local people who use and rely on NHS services, whether they are regular service users or just count on it being there if they need it, deserve to have safe, sustainable health services. 'Tweaking' bits of the system in isolation from each other or changing only in response to external pressures will not deliver the long-term change we need for the NHS's survival.

"The onus is on us in the NHS to build the case for change amongst the people we need support from, so that 'reconfiguration' stops being a dirty word and starts to represent the kind of planned, well-evidenced change programme which the NHS deserves."

Jeremy Taylor, Chief Executive, National Voices, says:

"Patients are not best served by the current pattern of services. For the safest, highest quality care, hospitals need to be organised differently and more services are needed closer to people’s homes. But the changes needed are often highly controversial. The NHS has often failed to make a good case; to involve patients and communities in ways that would build trust and to follow through to ensure that the new pattern of services is better than the old. And the public are rightly suspicious of closures and downgrades that seem to be more to do with money than quality of care. It is hardly surprising that local politicians often rush to defend the status quo – even if it is not the longer term interests of patients.

"The NHS has always evolved to meet changing needs. We need a more honest debate and a better way of making the decisions. This should not be about the NHS getting smarter at public relations, but about working with patients and citizens to jointly shape the decisions."

Professor Terence Stephenson, Chairman of the Academy of Medical Royal Colleges, said:

"As clinicians, patients are at the centre of everything we do. Changes in how the NHS delivers care will need to happen to continually deliver high quality patient care in the future. These changes cannot be delivered by one group alone. We believe that bringing together clinicians, patients and managers is vital to ensure that everyone is working together for the same standards of care. We want to create a culture of joint working, where it is normal for patients to be involved in every stage of designing their healthcare. Leading positive change together will ensure that we are able to deliver the excellence in care people have a right to expect from the NHS."