Liam Cahill’s Post

Transcript

Is the NHS viable and dot dot dot is that a static question? My name's Liam Cahill. I advise NHS organizations, health tech companies, national bodies and so on about innovation and digital in the National Health Service. And I think at the moment, you know, we've seen and heard enough discussions around how challenging and environment the NHS can feel. And one of the questions that people ask is like. How vital is it? When's it going to get better? Is it always going to be this way? Should we go to another market? Should we do something different? And I can't speak to the merits and viability of other markets, to be totally honest. But what I can say and what I always find that I end up talking about with organizations, is the current viability and the fact that the NHS very much works in cycles and there's a number of different micro and macro cycles that happen within the system. And I'd just like to provide some context on that actually. So the micro, so the micro cycle that I talk about quite a lot is the NHS financial year. That's kind of the main micro cycle that happens in 12 month cycles. And there are periods of peak and are periods of through. There appears are busy, there are periods of open, accessible and available and there are periods of just really ******* busy, especially with winter crises. But we also have a number of longer term periods where we have macro cycles and I think at the moment what we're seeing. In terms of viability is kind of the happening of some quite major events in the National Health Service, which has kind of created multiple overlapping cycles that's made it very difficult for things to be properly embedded and for innovative work to happen. And so I'd just like to talk through some of them. The first one, the first obvious major one is the NHS reform that obviously happened because a couple of years ago, yeah, couple years ago or is still basically happening. Now in that change in a system, what you will often see is that the in the run up may be sort of a year and a half and sometimes two years given if they're reform is really big which is one has been and it was the same in the landslide reforms before. You tend to get to a point of status where people see themselves in systems as legacy, right. So they go, well we'll keep doing our existing job, we'll keep doing things we do. But when you try and put something forward that's really innovative or radical or new. In their mind, they might be saying, well, hold on. Our system priorities aren't clear yet and we don't wanna start something really big that might then change and might start to, you know might not fit with the new system objectives. And so obviously that is a quite a key one. Then we go through the reform and the disruption, I don't mean the positive disruption, I mean the just general disruption of a reform that happens which tends to take place over a sort of 6 to 12 month period. That's when literally people are applying for new jobs, they're filling roles and doing all of that kind of stuff and then you tend to get that. Post reform curve where you know, they will go from a period of sort of, you know, decreasing capability. They're finding their way, they're working together, new teams, they're setting priorities and they're kind of going through. Now we are in that period where if we look back over the last 12 months, what we've seen is that the reforms happened. And then generally with big philosophical reforms like we have in the NHS at the moment, what you tend to have is a couple of sort of checkpoint reviews. So we've had the fuller review which has looked at. Integrated care boards. And then we've also had the Hewitt review which happened earlier this year. Our time is weird nowadays and and obviously at the moment what that's meaning is that users kind of like a look at tweaking and reconfiguration because the philosophy will have come in, the structures will have come in, but the mechanics will kind of need to be looked at to make sure they're getting it right. And so in the system reform, what we're kind of seeing is that we're kind of we've had these big reviews and what we're now looking for as well, how's the system then going to tweak and change its. Priorities in order to do that. So for example, here if you talked about prevention and upstream, you know, which I'm sure has no doubt has had an effect on the major condition strategy coming out quite recently and stuff like that. That leads kind of into a place where we still have a degree of instability and a degree of sort of systemic discombobulation that kind of comes through. So that's one where ideally if that was just the case and you had stability, what you would see is that we would see increasing capability, more innovation can come through and things can kind of get better, but there's a problem. Because we now in the other macro curve which is election cycle and obviously in terms of election cycles, we haven't necessarily had this for quite a while, but it plays a really, really big role right in that. What you will have is that pre election a lot of people within the system, particularly the national tiers of the system will firstly be on short term activities. I'm sure. The system would disagree with this, but realistically what you tend to have is particularly when church and state has kind of been sort of disintegrated, the separation between the two has been disintegrated and there's much more sort of direct sort of interventionism and the ability to do so by the Secretary of State and by the leaders in the HSE and the NHS England. What you tend to see is you're getting pushed through around short term targets and things which are running up to the election season. Because obviously you know any political party will seek to kind of get some wins in the run up so they can say they're doing lots of different things. And we've seen this in for example, I think it was like digital for example, we had the the 5 + 1 or 6 + 1 plan. I can't remember the exact numbers, but which came through and that was very much saying we're gonna hit these target areas where we can talk about it, but it's gonna be very short term, it's gonna have these. And I would imagine in terms of the major condition strategy, we're going to see the government pushing through some of these. So the idea is quite sensible and I imagine it will continue through in terms of the underlying model for it. So what this now means is that we have the run up where we have short term. Then we have the election cycle where you have Purdy where basically nothing happens because of legal reasons, statements can't come out, big policy intentions because why would you before you potentially about to change government. Then you have the new government coming in and people think oh great, so let's say the election is May 2024, yippee Doo dah gonna jump in and everything gets back to business as usual. Not so fast because this is where the clash happens with the micro year cycle because in terms of budgets and policy. Tensions. When you set it at the beginning of one year you there is some wiggle room, but generally they try to have stable and HS financial years for obvious reasons, particularly in a system which is struggling as much as it is. And So what you tend to find is that the for example, let's say as the polls would suggest at the moment, Labour gets in on the middle of May 2024. Realistically they're bigger. Changes in intentions won't actually properly come into force until the 1st of April 2020. Life. So as a system, if we're talking about viability, we've just had this run up to the reform, big system reform, mechanical tweaks now starting to kind of come out of it. But then we have this instability around short termism try and look at the system change. Then we've just got this period where the system is between arguably May 2024 and April 2025. We could end up with a situation where. They're playing out the previous administrations policy with a few tweaks and priorities, But priorities to be tangible and tractable in the NHS need money assigned with them and that realistically we don't start to see some stability and change. Now let's add in system reform back into this measure and think about that now from what Labour has said that they intend to do. Obviously we won't be huge system change after after Tories come in if that's the case. But let's say Labour does come in different administration. Look at that scenario, right and that comes in now If for example they decide to get the pot out and start chucking different ingredients in and reforming which I don't think they will cause, they're largely supportive of the principles of the current NHS and integration as an international phenomenon that's happening in major health systems. So I don't think we'll see that. And also the major condition strategy and the long term plan, the long term plan was widely supported across the board. So I don't people gonna see major reform. And also. The NHS needs doesn't need another way to reform right now, but let's say we go back into this situation. There is still gonna be a degree of waiting to then find out what the operational priority is. So theoretically, commissioners and system leaders could arguably go back into legacy mode. What that means is in September 2023. The question around viability, around specific areas, around being able to get more ambitious targets through or more risky particular piece of work as a question mark. Does that mean that we have to wait until the 1st of April 2024? Of course there are other cycles like the Pandemic cycle which was hugely unexpected, which was a cycle before that cycle it through the long term, plan up and create a whole new set of priorities. So I think. I refer to the environment we're in at the moment as a bit of a hurricane, but actually I think realistically it's probably a hurricane and a series of twisters inside that that we're trying to deal with and it feels difficult. And if we're questioning the viability, understandably so, because actually we have a sort of condensed series of cycles that are massively affecting how the system thinks and functions at that time. But the key point I'd like to just kind of raise here is that this is cyclical. And looking at the cyclical side of the system is important because the viability of the NHS or health and social care is not a static question. It's a constantly moving question. And you know, from a systems perspective, I think very much so that this is something that we should be thinking about where in the cycle are we and what does that mean? I hope this has been helpful talk through in terms of thinking about where the system is and the current level of viability in the future level of viability. I'm sure talking when I talk to health tech companies and other kinds of innovators and investors, and they're like 2025. This is just my view of where we potentially will be. Obviously, there'll be less disruption if the conservative administration gets back in next year, although obviously that have different forms of consequences in terms of what we see coming through. Have a lovely day. Hope you're keeping cool wherever you are.