Leading transformation in difficult times

It would be hard to think of a time in the history of the NHS that it has faced such a complex mix of pressures as it faces currently. Top line economic and social pressures, such as the need to significantly restructure overall operating costs, while at the same time managing long-term increases in demand brought about by an aging population, are mixed with structural change pressures caused by changes to commissioning, the dismemberment of key parts of the healthcare system and the drive to increase local autonomy and accountability for the delivery of services. Collectively, these pressures create perhaps the toughest management environment in the history of the NHS, just at the time that organisations are cutting the very managers needed to manage the response to the pressures. From 1997 to 2010 funding for the NHS increased from £35 bn to £110 bn. However, this funding increase was balanced by an increasing demand and increasing costs associated with delivering healthcare, triggering numerous “Cost Improvement Programmes,” designed to make local efficiency improvements in areas where costs and funds were not in balance. However, the scale of change required today is of an order of magnitude greater than previous initiatives and requires a very different approach and different mindset. The change in the economic and operating climate is sending shock waves through organisations as teams struggle to find ways of cutting costs while still having to deliver safe and effective services and the emotional challenges surrounding the loss of colleagues and changes to everything around them, from procurement to pensions.

A new breed

Managing the transformational change in this environment will need a new breed of senior leader, both operationally and clinically. This change in management approach will need to be accompanied by the introduction of new processes to manage performance such as “Service Line Reporting” which gives a view of the efficiency (and in commercial terms profitability) or otherwise of services. Tough decisions will need to be made about the services delivered and who delivers them at the health economy level. At the level of individual organisations this means leaders having to operate with less, communicate with staff and partner organisations more, as well as become more flexible about how care is delivered and managed. Community healthcare organisations have emerged from the shadow of Primary Care Trusts over the last few years, leading to numerous mergers as organisations have grouped together to realise efficiencies and meet minimum organisational size requirements while at the same time seeing them having to build new commercial and operational relationships with their colleagues in other parts of the health economy. One community healthcare organisation that has faced up to the challenges is Hounslow & Richmond Community Healthcare (HRCH) which was formed by the merger of the Community Healthcare provider arms of the PCT’s of Hounslow and Richmond in April 2010.