There should be a thought at the heart of every organisation; are we doing good or ill? In Microsoft we worried about a new found monopoly and we engaged with this through responsible leadership. We understood that our role as managers had to change, we had a responsibility to our partners and customers beyond just making money for our shareholders. And over a number of years we became a better group of leaders.
In the NHS I am not sure we have yet to fully understand the constraints and opportunities afforded to us by our health and social care monopoly in England. Monopolies nearly always display a number of traits:
- A lack of transparency
- Poor levels of service.
- No or low consumer power.
- high prices for low quality goods and services.
- out dated goods and services with little or no innovation.
I believe that these ought to be leadership concerns of NHS England.
Despite rises in medical legal costs through greater insurance payouts and premiums, the Francis Report and the Institute of Customer Service Report 2014,that shows lower and lower levels of customer satisfaction within the NHS, the NHS has yet to focus managers in the same way as those of the commercial sector near monopolies.
It may that the NHS has never really developed, in organisational terms, beyond the passive aggressive org that Neilson so graphically describes in his Harvard Business Review article.
It’s time we all demanded more of NHS leadership, the call for privatisation is the wrong way of tackling the issues of lack of competition. NHS Leaders should address the monopoly traits. This could be achieved through greater transparency, and by commissioning services for improvements in public, patient and professional experience.
There is some light at the end of the tunnel, the Kings Fund paper Reforming the NHS… is a very good place to start. But until the traits are on the agenda of every NHS leader we are not going to make progress.
I was sitting in a meeting a couple of years ago discussing how governments used personal data,in the room were high panjandrums from every department of state plus a few people from civil liberty and allied organisations.
We came to the point when someone suggested that truly joined up personal information available to all government departments would be a real benefit for the citizen.
The libertarians were horrified. They were worried that Healthcare data could be cross matched with welfare payments and when discrepancies were found the citizen could be tried, convicted, a prison space made available and the Police would snatch the person from home and take them directly there.
I pointed out that it would be worse than that. The reality would be that data would be wrong and before we knew it the Government would be correcting us instead of the data. In my case I presume some surgical operation would be conducted to remove 10inches from my height to make sure it matched the “Official Data.” I can think of worse errors!
Governments think they know so much about us but in reality the real danger comes from companies like BT and Google. This TED talk explains the concern.
Marketing is not popular in the corridors of Whitehall, it is seen as a waste of money, often confused with advertising and thought of as only relevant to commercial organisations. As a result the management processes of marketing are avoided and never discussed. Programmes and outcomes are defined in technical and economic terms. As a result the citizen is rarely thought of or given a voice.
Commissioners of public sector health and social care services put in place the standards and values of the outcomes they want to achieve. It’s important to understand that the frameworks leaders use to define programmes effect those outcomes directly. Set things up as Information Communication and Technology programmes and you get ICT led outcomes, set things up like Comms and PR and you get those. By being internally focussed and organisationally constrained a commissioner can miss the point.
Public Service Marketing is the management process to avoid such pratfalls , leaders need to listen to the requirements of the citizens, patients and professionals. Then, they should build and test cost effective offers to map to those requirements. In that way the offer/response is understood by the target population. In this way the chances of a successful outcome are great enhanced.
Recent marketing failures in health and social care services mean that we now need a tough conversation about the reintroduction of a set of tools that are designed to create cost effective outcomes. Rather than costing too much money the lack of public service marketing has cost the public, patients and professionals far more.
A number of people have asked me what is the promise of the NHS Constitution – here is my short summary:
1. The NHS provides a comprehensive service, available to all
2. Access to NHS services is based on clinical need, not an individual’s ability to pay
3. The NHS aspires to the highest standards of excellence and professionalism
4. The NHS aspires to put patients at the heart of everything it does
5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population
6. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources
7. The NHS is accountable to the public, communities and patients that it serves
The National Audit Office has been pretty scathing about NHS ICT systems. My charge is more serious. The NHS National ICT organisations have over the last 20 years, the current one is called the Health and Social Care Information Centre, failed to put people and patients at the heart of their systems and products.
By focussing on the technical and economic justification for programs and ignoring the requirements of the public, patients and NHS professionals, HSCIC haven been delivering technical and economic solutions. Sometimes this focus leaks out in public. Here is an example spotted on a bus in Chiswick last week.
It is not hard to put people at the heart of what you do. In the NHS it is easier when you have read the NHS Constitution. By understanding the promises at the heart of the document you have a check list to make sure your ICT ticks off all of the requirements.
More importantly if you don’t take care to meet the needs of the Constitution then Commissioners and auditors are likely to find your delivery inadequate.
Consumers of health and social care services have 5 concerns:
- They do not have trust and confidence in the complaints system
- They are afraid to make a complaint close to the source of their care in case it affects how they are treated
- They do not believe that making a complaint will make a difference and that nothing will change as a result of their complaint
- They do not know who to complain to
- It can be bureaucratic and intimidating
They have 8 simple principles:
- Trusted and confidential.
- Responsive: Almost half (49%) of people have no confidence that their complaints will be dealt with effectively.
- Supportive: It takes courage to complain, don’t make it harder.
- Simple: The current complaints system is complex and simplification is paramount.
- Joined up: Consumers and users of services should be assured that lessons will be learned by the whole health and social care system – not just the individual health or care setting complained about.
- Integration between health and social care: Many issues arise at the junction of care, where a provider, ward or department changes or where an individual passes from health to social care provision.
- Transparency: The consumers can make effective choices about their health and social care.
- Complaints data and benchmarking: It can be the catalyst for service improvement and innovation
Do we need a Health and Social Care Digital Service in England to offer the public high quality and easily understood information and services relevant to health, well-being, NHS and care services?
A digital service could be underpinned by the principles of greater transparency, more high quality information and activated participation.
I think such a service might include:
- Transparency – Directly connect people to transparent information about health and care, and associated services to enable them to make effective decisions about their health and care needs, such as choosing when and where to access care & advice.
- Transactions – Provide a range of simple, relevant and timely online services, to enable people to transact their health and care online, such as booking appointments, ordering repeat prescriptions or accessing a care record when they want to.
- Provide an effective transactional service to deliver system-wide efficiencies enabling services and transactions to be shifted to digital channels, such as ordering repeat prescriptions, advanced symptom checkers and appointment booking services.
- Participation - Provide a service for participation in individual health, care and third party services, such as managing a long-term condition, for example diabetes, with online tools and communities for peer support and advice
- Enable people to provide feedback on their experiences of health and care and ensure that they are listened to and their comments acted upon.
- Efficiency – Provide opportunities for GPs, hospital clinicians, NHS organisations and 3rd parties to create and exploit new ways of working such as streamlining care pathways, providing lean processes and reducing administration costs.
- Building the Market – Make available open and accessible interfaces so that third party organisations and developers can access the digital service data and information to create innovative products for consumers to further improve the variety of tools & services available, catching up with many other sectors that have embraced the digital revolution and empowered their customers.
- Enable small and medium organisations to provide digital service innovation through access to NHS business processes and partners.
Perhaps a digital service could be the clicks to the NHS and social care bricks. It might provide a catalyst for a digital transformation of the way the NHS and care organisations do business.