Darzi NHS Review – the sequel: City St George's experts respond
Lord Darzi's second review of the NHS is right to highlight the role of leadership, prevention and rational planning of hospital services, City St George's experts say.
Les Mayhew, Professor of Statistics at Bayes Business School, said:
“Lord Darzi’s review highlights the need for prevention and early intervention. The U.K. is a world leader in health inequalities research, yet our research work demonstrates just how pernicious health inequalities in England are.
“The UK is grappling with a population health crisis. We’re living longer but in many places reversing the improvements in health we’ve seen over the past decades. And the evidence suggests things will get worse before they improve.
“We need to be bold if we are to tackle this health divide. It’s not inevitable. But to turn this around, we need to better target services at communities and age groups that need them most. We need to invest more in preventing the things that do us harm – and we need much stronger regulation to make sure the healthy choices become the easy choices.
“With an ageing population the pressure on policymakers to intervene in behaviours that can cut short working lives and increase pressure on the NHS will become irresistible. We also have a strong evidence base for drastic interventions around smoking – even if the impact on disease and mortality data is a steady decline rather than the abrupt fall needed to hit the levelling up targets set by the previous government.”
Professor Amanda Goodall, Director of Bayes Business School’s Executive Master’s in Medical Leadership programme, said:
“It is significant that Lord Darzi highlighted the ‘crucial role’ of clinical directors and warned that ‘the role is poorly developed, supported and managed’. His review echoes many from the past, including his own review in 2008. that have said the health service has to invest more in leadership training and support.
Doctors in charge
“The best healthcare systems in the world have only ever been led by outstanding doctors and only after they have added the skills of management and leadership. Our best doctors are not centrally enough involved in decision-making at the top of the NHS or hospital trusts, and they have received virtually no leadership training when compared with other health professionals such as nurses. This needs to change.
“Our medical leadership programme equips doctors with the insights and skills needed to thrive and lead in a health service that will always face significant challenges given demographic changes. These doctors can fill the clinical director roles Lord Darzi highlights and other leadership positions. We have evidence of the beneficial impact of doctors who complete our programme in terms of doctors’ productivity and behavioural change.”
Dr Navid Izady, Reader in Supply Chains and Operations at Bayes Business School, said: “The recurring themes of long waiting times and low productivity in this report align with those from previous reviews. Proposals to shift the budget from hospitals to primary care and community services are useful (but also not new).
“Expanding primary care services can reduce demand for hospitals, while enhanced community services would facilitate the flow of patients out of the hospitals.
Where everybody knows your name
“However, it is crucial to prioritise continuity of care in primary care expansion. Research suggests that when patients visit the same GP, the time between successive visits increases substantially – a factor that could alleviate demand in the long term.
“We also need more collaboration among hospitals to reduce some of the pressure on hospitals. With patients more willing to travel for shorter waits and with variability in service use across facilities, sharing capacity for some critical services among hospitals serving a region could help reduce waiting times. Integrated Care Systems should facilitate such collaboration.
“In the long term, reconfiguration of services across multi-hospital networks, specifically determining which services should be provided at which facilities and at what capacity, may be essential. Proximity to patients is becoming less important in such decisions given the pressures on the NHS. Other factors, particularly economies of scale, scope and focus, are becoming increasingly more important.”
Professor of Management Amit Nigam said: “Reengaging the workforce is key and this involves tapping into their professional values and public service orientation. Too many professionals feel a sense of burnout or a sense of moral injury. The latter is a form of emotional distress caused when the system they are working in does not offer an environment where they are enabled to deliver the standard of care that they, as professionals, expect to deliver. Reengaging staff is important, but it means making tangible progress in creating an NHS that taps into their professional norms, and that routinely enables them to deliver the standard of care that they, as professionals, have been trained to expect.
“Innovation – including innovation to shift care towards communities as well as innovation to improve work processes and use new technologies – is clearly necessary. Achieving innovation, however, can only happen under two conditions. First, there has to be some slack: people need some time not focused on the day-to-day work in order to identify and start to implement improvements, and the ability to access the financial resources needed to make support change and to experiment.
“If you run too lean in terms of staffing and resource, you cannot innovate. Second, clinicians and managers close to the front line know best where improvements can be made. They need the authority to experiment, and a sense that the organization is aware that not all experiments will succeed.”
Lecturer in Management Dr Amit Rawal said: “Whilst the NHS report depicts the positives of the service, there is a lot of work to be undertaken for the NHS to progress so it is in line with other countries in terms of an array of metrics. In particular, public satisfaction, responsiveness and it’s leadership are under great scrutiny; this is more prevalent post-pandemic. This will require increasingly more emphasis on inclusion, upskilling, and overall talent retention for the organisation to reach it’s intended objectives and to maintain the progress already made. With changing government and policies, further funding is required for the NHS for it to also reach such objectives.”
Investment in new digital technologies
Central to Darzi’s prescription for reforming the NHS is the need for greater capital investment in new digital technologies to improve performance. The Centre for Health and Social Care Innovation Research (CHIR), a unique interdisciplinary venture between Bayes and the School of Health & Psychological Sciences, believes that this approach is bound to fail unless it addresses the bottlenecks which prevent such innovations being spread and implemented more widely, more equitably and more rapidly.
CHIR Co-Director Dr Charitini Stavropoulou commented: “Our research shows that simply pushing new technologies into the NHS will not improve service delivery or patient safety unless we make NHS organisations and professional groups more capable of assimilating and managing the level of change involved. If this does not happen, new technologies will likely be solutions in search of a problem, and will fail to connect with the systemic needs of the NHS.”
