Transformation in the NHS

Transformation is a tricky word. While the dictionary definition reads “a complete change in the appearance or character of something or someone, especially so that thing or person is improved,” we expect the transformation to be rapid, effective and complete. Yet behind every overnight success is usually about 10 years’ worth of planning, persistence, perceptiveness and possibility. Here Melanie Relf, Senior Consultant Healthcare Strategy + Planning at ETL talks about where we are on the transformation journey of the NHS.

modern building Jon Tyson

Where did the concept of transformation come from?

Transformation was introduced in the government’s Five Year Forward View in 2014 to close the three ‘gaps’ in healthcare: in health & wellbeing, care and quality, and funding and efficiency.

The Five Year Forward View was reinforced by the NHS Long Term Plan, released in January 2019, which provided a 10-year plan with more wide-ranging healthcare improvements.

Of course, the Five Year Forward View and the Long Term Plan were written before the arrival of COVID-19, which only emphasised the value of the NHS while simultaneously brightly highlighting its shortfalls. Although many of the plans articulated in the Long Term Plan are currently paused, it is clear that much of this work will and must continue as the new normality resumes.

The Long Term Plan identifies the following focus areas, chosen to maximise the impact across the population:

  • Maternity: halving stillbirths, maternal and neonatal mortalities, and serious brain injuries by 2025 and increasing the number of neonatal intensive care beds
  • Cancer: speeding up diagnoses, extending screenings, overhauling diagnostic services, and ensuring that an initial yes/no diagnosis is received within 28 days, through the introduction of Rapid Diagnostic Centres (RDCs)
  • Mental Health: additional help for people with depression, anxiety, and severe mental illness, and increasing availability for children and young people’s mental health services
  • General practice: a fundamental redesign of outpatient services through technology
  • Cardiovascular disease (CVD): improving detection and care of CVD to prevent unnecessary cases of heart attacks, strokes, and dementia.

Why do we need a transformation of the NHS?

Modern medicine has made tremendous advances in identifying and preventing illness, yet its evolution has no end as society continues to change creating new health challenges.

For one, as a population, we are living longer and therefore more chronic and complex long-term health issues are prevalent. We are suffering increasingly from self-created, preventable diseases because of unhealthy choices including obesity, smoking or excessive alcohol consumption. To prevent but also to treat these long-term illnesses we require tailored and sophisticated treatment.

This brings us to the second point, which is the importance of information and choice when it comes to our own healthcare plan. To achieve the level of personalisation that is desired, the transformation of NHS services is required to collate, compare, predict, diagnose, and treat at unprecedented levels in unprecedented ways. Furthermore, we expect to be treated equally, no matter our location, with an equal outcome, and we should be able to rely on joined-up thinking between all aspects of the healthcare system.

Finally, there is a well-publicised backlog in maintenance in NHS property, paired with a lack of staff to fill vacancies and long waiting lists for certain services which must be resolved.

What will we need to secure transformation?

In order to effect such an ambitious transformation, we will need:

  • New, easily cleanable, sustainable, efficient, bright buildings that help staff deliver the new models of care and give patients the confidence that they are in the best possible place
  • Cutting-edge equipment that performs the required task in a streamlined, effective way
  • Technology that is harmonised, supporting connected facilities for a truly holistic healthcare system, that facilitates easy communication with the population at every level of care
  • A well-trained and fully supported workforce that understands they are valued, led by an exemplary, strong and focused leadership base.

How will it be delivered?

The vehicles for delivering healthcare are being reorganised, moving towards population-based delivery, helping the NHS deliver more pertinent, tailored services to a region. Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICS) will work with Local Authorities supported by a single Clinical Commissioning Group.

There has been considerable thought applied to how to move forwards at a macro scale. The challenge now is to ensure, amongst all this reorganisation, that we have a serious, solid process at the project level, through robust briefing, clear communication and strong leadership. This must be paired with experienced healthcare designers who understand the complexities and the pitfalls, and clinical modelling that has been piloted and evaluated.

There has been little review of the impact, positive or negative, of the previous intervention predominantly delivered via PFI. The Nuffield Trust has collected anecdotal data which emphasises the importance of a robust briefing process. For example, standardised rooms, reconfigurable space, acuity-adaptable single-bed rooms, loose-fit planning to facilitate flexing without major intervention, the ability to isolate part of a ward and to initiate one-way systems have all been shown to be indispensable when managing COVID-19.

What will success look like?

Smart, sustainable, and clinically sound facilities, occupied by patients for the shortest viable time, cared for by appropriately skilled, highly valued staff, where the outcomes do not vary, and records of all health events are available as required is the goal. Furthermore, we should aim to see reductions in avoidable deaths, technological enhancements facilitating real-time results, and a health journey free from delay.

We are on the way, and we occupy an unprecedented position, but care and caution will pay dividends.